Pharmacy Preference Form Please complete the information below so we can send your pet’s prescriptions to the correct pharmacy. Pharmacy Name(Required) Pharmacy Name Pharmacy Address Street Address Address Line 2 City ZIP Code Pharmacy Phone #(Required)Do you already have an account with this pharmacy? Yes No *If you do not yet have an account, please contact the pharmacy directly to establish one before requesting prescriptions from our office.* Does this pharmacy accept written prescriptions or does it need to be called in? **Please call your pharmacy to obtain this information** Written prescriptions only Call in only Both Important Policy Acknowledgment: If you require us to call in prescriptions directly to the pharmacy, please note that we only place calls to pharmacies on Wednesday afternoons. You acknowledge that you will notify us at least 1 week prior to running out of medication to ensure timely refills.I acknowledge and understand this policy. I acknowledge and understand this policy. Client Name Client Name Client Phone #Pet Name(s)Pet's DOB / SpeciesBest Contact (phone/email)SignatureDate MM slash DD slash YYYY Δ
