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. Do you have our mobile app? If so, you may want to use the app to order your refill as you can upload pictures of the medication or food and can securely pay there as well. Yes, I am headed to the app to upload pictures of the products I am refilling! No, but I would like to download it and use it to order now Yes, but I prefer to use this form today No, I prefer to use this form to order today How would you like to get your refill?(Required) Shipped to my home Pick up at Healing Paws Veterinary Care No preference Other 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 Home Click Here For All Other Products Shipped To Your Home HiddenSection BreakPet Owner Name(Required) First Last Please use a separate form for each refill you are requesting. We only process one product per refill form. Thank you!Phone Number(Required)Email(Required) Patient Name(Required) Please list the products you need(Required)Please tell us the amount you are giving and how often are giving it for each product - this is necessary for us to verify your prescription label(Required)Which would you like? One-month supply Three-month supply Six-month supply Other If other, please specify(Required) 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) As our medical team is also caring for patients, please allow 24 business hours to process refill requests. Our team will contact you when your order is ready!CAPTCHAEmailThis field is for validation purposes and should be left unchanged.