Pharmacy Refill Request Form

Please fill out the form below as completely as possible.

If this is an Emergency, please call our facility at 207-885-1290.

Pharmacy refill requests are monitored by MVMC staff Monday through Friday, 6:00am to 8:00pm and Saturday & Sunday from 7:00am to 7:00pm.

Please allow us up to 48 hours to process your request unless notified otherwise.

*If you’re requesting your pets’ prescription(s) to be refilled at a pharmacy/facility other than MVMC, be mindful of their processing time in addition to our processing time*

Client Name *

First

Last

Patient/Pet Name

Client Phone Number

Pharmacy choice (if other, please specify Pharmacy name, town, and street if multiple in that area)

MVMC
Other

What medication would you like refilled?

Ship to Client (Medication will be mailed to address on file via Fedex *additional charges apply*)

Change in shipping address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

*This form is for refill requests only*

Please call Maine Veterinary Medical Center at 207-885-1290 regarding all other questions, comments, inquiries, appointments, etc.

Thank You!
Maine Veterinary Medical Center Pharmacy

Pharmacy Refill Request Form

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