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Prescription Refills

If this is an EMERGENCY, please call: 561-746-5501.
After regular business hours, please contact Emergency Pet Care of Jupiter at
561-746-0555.

This prescription form is for use by clients whose pet we have examined within the last 12 months.

* Denotes required fields in order to submit the form.

Harmony Animal Hospital
1401 W. Indiantown Road
Jupiter, Florida 33458
Phone: 561-746-5501
Fax: 561-746-6114

*First Name:
*Last Name:
*Pet's Name:
*Phone: (Please include area code)	Home Work Cell
Phone: (Please include area code)	Home Work Cell
Phone: (Please include area code)	Home Work Cell
*Email:

Please Choose Your Veterinarian:


Prescription Request
Medication Requested	Dosage Size / Strength	Quantity Requested
*Name:
Name:
Name:
Name:
If your pet is taking medication for a chronic problem, please check the chart for special information or testing recommendations: Medication Chart
Phone number we can reach you at if we have a problem filling your prescription:

Additional Comments

Please be sure all of the required fields are correctly entered, as this will help us expidite your order request.

If you sign up for our EZ Fetch Refill
Program there is no charge for automatic shipments of many of your pet's medications. Please let us know if you would like to sign up.

This 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. For your convenience, the prescription may be picked up at our drive-up window.

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.

Harmony Animal Hospital - 1401 West Indiantown Rd. - Jupiter FL 33458 - Phone (561)-746-5501 - Fax (561)-746-6114
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