Prescription Refill Request

This form is for clients who already have a file with our hospital. If you are not a client, please call us at 450-433-9303.

Pet's Name *

Name of owner on file *

Telephone number on file *

Email address *

Name and/or description of the requested medication *

Has anyone ever prepared this prescription for you? *

Yes
No

Do you want to add other medications? *

Yes
No

Add an external prescription

Accepted file types: jpg, gif, pdf, png, jpeg, Maximum file size: 5 MB.

Desired mode of communication for prepared prescription confirmation? *

Email
Text
Phone

*Important: note that you must allow 48-72 business days to obtain confirmation that your prescription is ready for pickup.
*If we are unable to renew your prescription, a technician will contact you by telephone to notify you and to schedule an appointment with your veterinarian.

For any questions, do not hesitate to contact us by email at hopital.blainville@accesvet.com or by telephone at 450-433-9303.

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

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