Prescription/Food Refill Request Form Please complete this form to submit a refill request for your pet. If you have any questions, please call us at 717-462-9480. Pet Owner's Name(Required) First Last Phone Number(Required)Email(Required) How would you like to get your refill?(Required) Shipped to my home Pick up at Healing Paws Veterinary Care Outside Pharmacy Request No preference If other, please specify(Required) Order Purina ProPlan Foods, Fortiflora, and Calming Care Here. Please use code 9HDXZ. Order Medication and Supplement Refills, Royal Canin and Hill's Foods Here.Click Here to Order Purina Products Shipped To Your Home Please use code 9HDXZ at check out.Click Here to Order Hill’s Science Diet Products Shipped To Your HomeClick Here For All Other Products Shipped To Your HomePlease visit our Healing Paws Veterinary Care Online Store, which is linked directly to your pet's medical records, allowing us to ship products to your home straight from our distributor without the need for you to come to the clinic to pick up a written prescription. Our online store products allow you to support us as a locally owned small business, trust that the products you receive are accurate, and order easily at any time, day or night and because it goes straight to you from the distributor, the cost is less than picking up products at our clinic. Most big box online pharmacies are now requiring "wet signature" written prescriptions. These prescriptions take five business days for us to process and require you to pick up the prescription in person from Healing Paws, and then you must post-mail the prescription to the online pharmacy you have chosen. Our Healing Paws Veterinary Care Online Store skips these steps completely. Please remember, if choosing an online pharmacy other than our direct distributor, you should always follow these FDA Choosing an Online Pharmacy Safety Recommendations.Please choose one of the following options:(Required) I would like to quickly order now from the Healing Paws Veterinary Care Online Store I have not used the Healing Paws Veterinary Care Online store before, I would like a team member to review the products I need and send me the online store link with a 10% coupon! I have read the above and decline the 10% coupon. I understand the above and release Healing Paws Veterinary Care and its employees from any responsibility regarding the safety and accuracy of products I purchase for my pet through third party online pharmacies. I understand that a written prescription takes 5 business days to process and I am responsible for picking up that written prescription and submitting it to the pharmacy of my choice. Click here to visit our online pharmacy!HiddenSection BreakPatient Name(Required) List the first product you need refilled (one product only, you will have the ability to list others later in this form).(Required)How much are you giving your pet and how many times a day?(Required) We recommend always having 2-4 weeks extra of long term prescriptions on hand, how much of this product would you like to order?(Required) One-month supply (if available) Three-month supply (if available) Six-month supply (if available) Other Do you need other products refilled for this pet?(Required) Yes No If others, please name the product/s in detail.(Required) How much are you giving your pet and how many times a day?(Required) We recommend always having 2-4 weeks extra of long term prescriptions on hand, how much of this product would you like to order?(Required) One-month supply (if available) Three-month supply (if available) Six-month supply (if available) Other How is your pet doing on these medications or food (same, better, worse, etc.)?(Required) Are you having any trouble getting your pet to take these medications or food?(Required) If so, our team will evaluate if there are better options to help make things easier.Within what time frame will you run out of the food, medication, or product?(Required) Our doctor and staff that fills prescriptions is also the team that cares for patients and sees appointments, prescription refills, and written prescriptions have a five business day processing time. If you need your refill more urgently and have told us so above, we will do our best to meet your needs but may not be able to get the product for you earlier d ending on stock and staffing levels. Due to nationwide stocking shortages and shipping delays, we also recommend that you always keep 2-4 weeks extra of food and prescriptions on hand at your home. Thank you.Date(Required) MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.