Welcome to Eudora Animal Hospital

If this is an EMERGENCY, please call (785) 542-3265

* First Name:
* Last Name:
* Pet's Name:
* Phone #:
* Email:

Please Choose Your Veterinarian:


Prescription Request
Medication Requested:	Dosage Size / Strength	Quantity Requested
Name:
Name:
Name:
Name:

Phone number we can reach you at if we have a problem filling your prescription:

Comments

* The refill form is for the convenience of our clients that 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. An email confirmation will be sent for filled requests.

Federal and State laws, as well as good medical practice, prohibit us from dispensing prescription medications without prior examination of your animal (within the last 12 months), and current knowledge of your animal's health. We are similarly prohibited from dispensing or refilling medications that were originally ordered by another veterinarian. We will be happy to dispense any needed medications after examining your pet. Kindly give us at least 24 business hours after submitting this form. Please call before you come to be sure that your pet's prescription is ready.

Let us know if you would like your prescription mailed. We will call you for a credit card number. The packaging and mailing fee is $5.00 for most prescriptions.