Rx Refill

Brown Veterinary Housecalls

3735 E. Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

Prescription Refills

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by Dr. Brown. Please allow 48-72 hours for prescription refill approval and contact your pharmacy directly to ensure the Rx has been filled and is ready for pickup . An active client patient relationship must be current to legally approve any refills. If your pet has not been seen by Dr. Brown in over 12 months refills by law will not be authorized.

Prescription Refills Online

Name (required)

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

E-Mail Address (required) :

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone
Phone Type	Phone Number

Pet's Name (required)

Sex (required)

Male
Female

Age: Years, Months

Have we seen your pet within the last year? (required)

Yes
No

Medication Requested (required)

Dosage and frequency giving medication-Required (required)

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Colleen Brown DVM

Integrative Veterinarian

(480) 494-6034

Brownvethc@gmail.com

Phoenix, Arizona

Mesa, Gilbert, Tempe, Chandler, Scottsdale, Fountain Hills, Paradise Valley.

(Extended service area considered/subject to availability/additional fees apply)

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