Outside Third Party Pharmacy Prescription Request Form

OUTSIDE THIRD PARTY PHARMACY

 Please submit this required third party pharmacy request form only if you decline a complimentary written prescription to use directly via the pharmacy of your choice and wish for Dr. Brown or remote staff to phone in your pets new or refill prescription directly to an outside third party pharmacy 

 There is a $22 fee per call for the time that is needed for Dr. Brown & remote staff to communicate directly with outside third party pharmacies

 Note: If your pet is under the care of a specialist or full service brick and mortar clinic for services not provided by Dr. Brown and has been prescribed medication by doctors at said facilities, all refill requests for medications not prescribed by Dr. Brown must be directed back to the prescribing doctor at said facilities. If the patient will no longer be seeking care at said facilities but contacts Dr. Brown to fill said medications, then either an updated exam by Dr. Brown or fee based TeLeVET Time to evaluate records/diagnositcs/labwork from other facilities will be required and determined on a case by case basis

 COMPLIMENTARY WRITTEN PRESCRIPTIONS MYVETSTOREONLINE

PROCESSING INFO

 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 CLIENT PATIENT RELATIONSHIP (current exam by Dr. Brown within 12 months) BY LAW for refills 

IMPORTANT

 Please confirm directly with the third party pharmacy of your choice PRIOR TO SUBMTTING THIS FORM that the medication being requested is in fact carried by your chosen pharmacy

 Please contact your third party pharmacy of choice directly for processing updates