Medication and Allergy Vaccine Refills
-including oral, topical and Cytopoint refills
Client Name
First Name as it appears on our account
Last Name as it appears on our account
Pet Name
Type Name of Your Pet
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
How would you like to be contacted when the refill is ready?
Please Select
E mail
Text
How would you like to receive your refill?
Please Select
Pick up from the white box labeled AADC once you have been notified that your order has been placed in the box
Ship to an address
If you want your refill shipped, please choose shipping method:
Please Select
USPS Priority Mail ($9.95)
UPS Ground ($15-$25)
If your refill is being shipped, please provide the address to where you want it sent:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you ordering an allergy vaccine ($185)?
Yes
No
If requesting an allergy vaccine refill do you need syringes/needles ($10.95)?
Yes
No
If requesting oral or topical medication(s) refills or Cytopoint include the dose, how often given, and quantity of medication or topical product:
You can submit multiple requests on one order form
Comments:
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