Rx: Prescription Request Form for Outside Pharmacies
NEW & UPDATED PHARMACY POLICIES
In order to provide the best patient care possible, streamline refills and ensure only quality medication & products are delivered to patients, Dr. Brown is exclusively working with her trusted partner MYVETSTOREONLINE via Midwest Veterinary Supply and will no longer be authorizing prescriptions from outside third party pharmacies, online or local.
Clients can access MYVETSTOREONLINE directly from this site and create a pet account to receive instant savings, free shipping on qualifying orders and competitive pricing, all while supporting Dr. Brown as a local small business vendor.
COMPLIMENTARY WRITTEN PRESCRIPTIONS may be requested for owners that wish to continue to utilize outside third party pharmacies to submit themselves directly to the local or online pharmacy of their choice.
Written prescriptions are available during in person appointments or via local pick up at Soul Puppy (downtown Mesa office) or by mail. Please email email@example.com to request a written prescription.
Please submit this OUTSIDE PHARMACY REFILL REQUEST FORM only if you wish for Dr. Brown or remote staff to phone in your pets prescription to an outside third party pharmacy
There is a $22 fee per call for Dr. Brown/remote staff time
Note: the above fee is waived if a prescription medication is not available in MYVETSTOREONLINE such as controlled or highly monitored drugs, if the medication needs to compounded at a compounding pharmacy because an FDA approved product is not available for the patients weight or if directly waived per Dr. Brown
THANK YOU FOR YOUR UNDERSTANDING AND SUPPORT!
Note: For JIng Tang Herbal Refills please email firstname.lastname@example.org. Standard Process orders can now be obtained directly via Patient Direct.
Please allow up to 48-72 hours for refill approval and processing
Please request one medication per form to avoid errors
All patients must have an ACTIVE CLIENT PATIENT RELATIONSHIP (current exam by Dr. Brown within 12 months) BY LAW for refills
Please confirm directly with your third party pharmacy of choice prior to submitting this form that the medication being requested is carried by your chosen pharmacy. Please contact your third party pharmacy of choice directly for processing updates
Please schedule an appointment if it has been MORE THAN 12 MONTHS since your pets last exam
THANK YOU FOR SUPPORTING OUR SMALL BUSINESS ONLINE PHARMACY