YourVets: Repeat prescription order form

Please fill in the form below and click submit
for it to be sent to us via email.
Fields marked with an asterisk (*) are required fields.

Prescriptions received via email before 2pm will be ready for collection after 2pm the following day.

Title: *

Surname: *

Address: *

Postcode: *

Home tel no: *

Work tel no: *

Mobile:

Email: *

In your knowledge, have we seen your pet for a healthcheck within the last six months?: *

Yes No

Pet's name: *

Species (dog, cat, rabbit etc): *

Current weight (if known):

Name of medication required: *

Current dosage you are giving:

Quantity usually dispensed:

Please add any further comments you feel relevant in the box below:

Delivery service: Would you like your prescription to be delivered via 1st class post?

Yes No

Delivery service costs £1.80 and excludes food and insulin orders.

Please ensure that you have provided us with your telephone number above, so we can contact you for payment details.