Prescription Refill Form

Thank you for Prescription Refill with GPVC. Please complete the form below prior to your arrival so we may have as much information as possible to prepare for your dog’s visit. Once you arrive in our parking lot please call 503-245-7275. We will meet you curbside to bring your dog in for his/her exam. Please ensure their collar is secure and a leash is attached. We will be in touch very shortly to discuss our exam findings and your concerns.

Prescription Refill Form

Name

First Last

Phone

Pet's Name

Prescription Refill Information

You can add more than one prescription by clicking on the plus sign on the right side of this field.

Drug Name

Strength

Quantity

Comments

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