Briar Patch Veterinary Hospital
706 Elmira Road
Ithaca, NY 14850
(607)272-2828
fax (607) 272-2875


Briar Patch Veterinary Hospital

Welcome to Our Site

Prescription Refills

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by our doctor. We will let you know of any problems with your request.

We will notify you via email or phone when your pet's prescription is approved and ready to be picked up. We will also inform you of the total cost of the prescription.

If you would prefer to have the prescription mailed to you, please mention this in the additional information area. When we contact you to let you know your refill is ready we will confirm your mailing address. We ask that you provide a credit card number or payment by check prior to mailing. There is a flat-fee of $5.00 for postage and handling.

Form - Prescription Refills Online

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
E-Mail Address (required) :
Daytime Phone
Phone TypePhone Number
Evening Phone
Phone TypePhone Number
Pet's Name (required)

Sex
Male
Female

Have we seen your pet within the last year?
Yes
No

Medication Requested (required)

Additional Comments / Questions


The verification code below ensures the form is not submitted by a computer
Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.