3290 Fairfield Avenue - Bridgeport, CT - 06605 - 203-333-2195 - Email - - Contact Us
 

RX Refill Requests

Coming Soon!
Please fill in all fields so we can help you & your pet better.
  • If a refill request is made prior to 3pm Monday through Friday, and in-stock, your refill will be ready to pick up at our front desk before closing on the same day. 
  • Any refill request made after 3pm on these days or made anytime on Saturday or Sunday will be ready the following business day.
  • You will receive an e-mail confirming the receipt of your request.   
  • Should we have any difficulty processing your request, we will notify you by e-mail.
Personal Information
First Name
Last Name
Address 1
Address 2
City
State
Zip Code
E-Mail
Home Phone
Office Phone
Cell Phone
Patient Information
Pet's Name
Breed
(please be specific)
Date of Birth/Pets Age
Canine Yes

Feline

 Yes
Sex Male Female
Spayed/Neutered (Date) Yes
Weight
Medication Requested:
Name of Medication 1
Quantity Requested 1
Name of Medication 2
Quantity Requested 2
Name of Medication 3
Quantity Requested 3
Name of Medication 4
Quantity Requested 4
Questions and/or Comments
Please click submit button once.
It might take a few seconds to a minute to read your information.
      
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