Veterinary Eye Centers, PLLC
Contents of this page may not be copied, modified or redistributed without permission.
For problems or questions regarding this web site, contact web@veteyecenter.com
Last updated August 27, 2009


Welcome to Our Site

Prescription Refills

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

We will notify you via email or phone when your pet's prescription is approved and ready to be picked up. We will also inform you of the total cost of the prescription, and will request a credit card number by phone at that time.  If you would prefer to have the prescription mailed to you, please mention this information in the additional information area.

If you need an urgent refill, please call the hospital at (512) 255-8700 instead of using this online form.

 

Form - Prescription Refills Online

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
E-Mail Address (required) :
Daytime Phone
Phone TypePhone Number
Evening Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Sex (required)
Male
Female

Age: Years, Months

Have we seen your pet within the last year?
Yes
No

Medication Requested (required)

Additional Comments / Questions

Text Field


The verification code below ensures the form is not submitted by a computer
Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.