Third Party Pharmacy Rx Request

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

 Outside Third Party Pharmacy Prescription Request Form


Photo of dogs by a phone and computer copyright paid canva

medicine iconPOLICY & PROCESSING INFO

  • Third Party Pharmacy Policies
  • Please allow up to 48-72 business hours for approval and processing
  • Please request one medication per form to avoid errors 
  • All patients must have an active VCPR by law for refills 
  • There is a $22 fee per call for the time that is needed for Dr. Brown to communicate directly with outside third-party pharmacies. This is for local phone friendly pharmacies only i.e. Costco. Dr. Brown does not communicate with phone UN-friendly pharmacies or third-party internet pharmacies under any circumstances. Complimentary Written prescriptions required for the later. 
  • Please confirm directly with third-party pharmacy that the medication being requested is in fact carried by said pharmacy
  • Please contact third-party pharmacy directly for processing updates
  • All required fields must be filled for form to process

Outside Pharmacy Request

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Email address (required)

Cell Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Sex

Male
Female


Age: Years, Months

Approximate weight

Has your pet been examined by Dr. Brown within the past 12 months? An active VRCP is required. (required)

Yes
No


Name of Medication Requested. ONE REQUEST PER FORM PLEASE (required)

Strength (Ex. 100mg) (required)

Dosage: (Ex. 1 tab by mouth twice daily) (required)

Name of third party pharmacy (required)

Phone number of pharmacy (required)

Cross streets and city of preferred pharmacy if applicable

Prescription number or order number if applicable

Fee payment ($22 fee per outside pharmacy call) Note: Owners may request a complimentary written Rx to submit directly or utilize MYVETSTOREONLINE (required)

Zelle via 480-494-6034 or brownvethc@gmail.com
Venmo via @brownvethousecalls
Paypal via drbrown@brownvetservices.com
Fee waived per Dr. Brown
Please send me an invoice



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Thank you for your referrals!

Family owned & operated since 2010

 

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Thank you for your referrals!

Family owned & operated since 2010

 

TeLeVET Button

House Calls Button

Equine Acupuncture Button

Soul Puppy Holistic Healing Button

In Home Euthanasia button