Heartland Veterinary Clinic, PC

Prescription Request

 

If you are a client at Heartland Veterinary Clinic of Harrisonburg and you would like to refill a prescription, please fill out this order form.

 

After receiving your order form, a staff member will contact you regarding your prescription. Your prescription will be available for pickup at the front reception desk.

 

Thank you.

 

Name on Account:

 

Phone number:

 

Your email address:

 

For each pet, type in the pet's name and select the medications they need from the list (hold the Ctrl key while you click to select more then one). If the medication is not listed, please type it's name under Other Medications.

 

Pet's Name	Medications Requested	Other Medications
	Amitriptyline Advantix Chlorphenirimine Cosequin Deramax Doxepin Enalapril Fatty Acid Capsules Frontline Plus Intercptor Proin Phenobarbital Revolution Sentinel Soloxin Tapazole
	Amitriptyline Advantix Chlorphenirimine Cosequin Deramax Doxepin Enalapril Fatty Acid Capsules Frontline Plus Intercptor Proin Phenobarbital Revolution Sentinel Soloxin Tapazole
	Amitriptyline Advantix Chlorphenirimine Cosequin Deramax Doxepin Enalapril Fatty Acid Capsules Frontline Plus Intercptor Proin Phenobarbital Revolution Sentinel Soloxin Tapazole
	Amitriptyline Advantix Chlorphenirimine Cosequin Deramax Doxepin Enalapril Fatty Acid Capsules Frontline Plus Intercptor Proin Phenobarbital Revolution Sentinel Soloxin Tapazole
	Amitriptyline Advantix Chlorphenirimine Cosequin Deramax Doxepin Enalapril Fatty Acid Capsules Frontline Plus Intercptor Proin Phenobarbital Revolution Sentinel Soloxin Tapazole

Please allow 24 hours for prescription refills.

 

* This refill form is for the convenience of our clients who have previously been given a medication by one of our veterinarians. The prescribing veterinarian will review the request, and you will be contacted if it cannot be filled for some reason.

 

Federal and State laws prohibit us from dispensing prescription medications without prior examination of your animal, and current knowledge of your animal's health

 

Certain medications require periodic blood tests to assure their safety and effectiveness. We will notify you if your pet requires any lab tests.