REPEAT PRESCRIPTION FORM

THIS IS A SERVICE FOR REGISTERED CLIENTS OF PORTLAND ROAD VETERINARY SURGERY, FELBRIDGE SURGERY OR EDENBRIDGE SURGERY ONLY.
 
Please complete the form below. Prescriptions will take 48 hours to process and we will endeavour to contact you if there is any reason that it cannot be filled.
 If you have any questions or problems filling out your request please call the surgery during work hours so we can help!
 
 

Repeat Prescription Request Form

I am a registered client at:
Has your pet been examined by our vets within the last 6 months?
Title
Address Line 1
Address Line 2
Email Address
Name of Medication (1)
Size of Medication (1) required (e.g. 25mg or 10ml bottle)
Current Dose (1)
Comments
Name of Medication (2)
Size of Medication (2) required (e.g. 25mg or 10ml bottle)
Current Dose (2)
Which Surgery would you like to collect from?*:
(Required fields are marked with a *)

Annual Health Plans

Click here for more information