Rx Refill

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

Prescription Refill Request

In an ongoing effort to make your pet's health care as convenient as possible, please submit a REFILL REQUEST FORM for your pet's prescription medication and diets, Chinese herbs, food or supplements. 

  • This form will be emailed directly to Dr. Brown for approval and processing.
  • Dr. Browns ONLINE ASSISTANT, DEB, may email questions or updates to you from the following emails
  • As Dr. Brown is typically with a patient or traveling for a housecall, THIS FORM EXPEDITES YOUR REFILL REQUEST.
    • Please do not email refill requests (no text or social media messages please). 

IMPORTANT:

  • Please allow up to 48-72 hours for refill approval and processing
  •  All patients must have an ACTIVE CLIENT PATIENT RELATIONSHIP (current exam by Dr. Brown within 12 months) BY LAW for refills 
  • For OUTSIDE PHARMACIES, please contact your pharmacy of choice directly for processing updates i.e Chewy, Walgreens, Costco, etc. 
  • 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


Refill Request Form

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

Daytime Phone
Phone TypePhone Number
Evening Phone
Phone TypePhone Number
Pet's Name

Sex

Male
Female


Age: Years, Months

Approximate weight

Has your pet been examined by Dr. Brown within the past 12 months?

Yes
No


Name of Medication, Herbal, Supplement, Diet/Food, etc Requested

Strength (Ex. 100mg)

Dosage: Number of pills/capsules/chews, route of administration and frequency of dosing (Ex. 1 tab by mouth twice daily)

Is this a refill for Dr. Browns small business online pharmacy? (Jatrx via Midwest Veterinary Supply)

Yes
No
No, but I would like more information and potential price matching if possible


Is this a Chinese Herbal Medicine refill (drop ship) from Jing Tang Herbal?

Yes
No


Is this a Standard Process Whole Food Supplement drop ship refill?

Yes
No


Name of preferred pharmacy

Phone number of preferred pharmacy

Cross streets and city of preferred pharmacy if applicable

Prescription number or order number


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