Prescription Refill Form

At Governor Animal Clinic, we make it easy to request your pet’s medications and prescription diets. Completing the Prescription Refill Form allows our team to process your request quickly and accurately, so your pet never misses the care they need.

Get Started

How to Complete the Form

Please take a few moments to fill out all required sections of the form. Be sure to include:

Your contact information
Your pet’s name
The medication or prescription diet being requested
Any special instructions or notes

Providing complete and accurate details helps us fulfill your request as efficiently as possible. Most in-stock medications can be prepared the same day, while some items may require additional time if they need to be specially ordered.

Submit Your Prescription Refill Request

Submitting your Prescription Refill Form in advance helps us streamline the process and ensure your pet’s medications are ready when you need them.

Name *

First

Last

have manufacturer Date

Email *

Primary Phone *

Do you agree to receive text messages from Governor Animal Clinic? *

I agree

By checking this box, you consent to receive informational and/or promotional text messages from Governor Animal Clinic at the number provided, including messages sent by the autodialer. Consent is not a condition of purchase. Message & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy.

Secondary Phone

Pet's Name *

Breed *

Weight *

Repeater

Drug Name *

Quantity of Drug *

Refill Notes *

We will do our best to have your prescriptions ready before the end of the business day. Some medications may need to be special ordered and shipped to us from the manufacturer or compounding pharmacy. We will notify you if the product you requested will be a "special order" item. For future "special order" items, please submit request at least 1 week prior to your desired pick up date. Please note that all prescriptions will need to be approved by one of our doctors and that a current exam of your pet (within 1 calendar year) is required by law. *

I agree

Phone number you can be reached at: *

Pick-up Date & Time *

Date

Time

If you do not receive a phone call to confirm that your request has been received and your prescription is ready within 24 hours of sending your request, please call our office at (858) 453-6312.

Name

If your pet needs medication urgently or is experiencing a health concern, please call us directly at (858) 453-6312. Online forms are not monitored for urgent or emergency situations.

Prescription Refill Form

How to Complete the Form

Submit Your Prescription Refill Request

Repeater

Ready for a visit?

Have a question?

Contact Us

Location

Hours