Repeat Prescriptions

Title

First name

Surname

Address

Postcode

Telephone number

Email address

In your knowledge, have we given your pet a healthcheck within the last 6 months?* In your knowledge, have we given your pet a healthcheck within the last 6 months?* Yes No

Pet's name

Species (eg. cat, dog, rabbit)

Current weight (if known)

Item 1

Name of medication/food required

Current dosage you are giving

Quantity usually dispensed

Item 2

Name of medication/food required

Current dosage you are giving

Quantity usually dispensed

Item 3

Name of medication/food required

Current dosage you are giving

Quantity usually dispensed

Please add any further information (eg. collection)

We would like to send you reminders about your pet’s health (e.g. vaccination reminders). We always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Please indicate below how you would like to be contacted: We would like to send you reminders about your pet’s health (e.g. vaccination reminders). We always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Please indicate below how you would like to be contacted: Text Email Post No thank you

Very occasionally we may send you promotional material (e.g. vaccine amnesty information). This will be no more than one or two times a year. We always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Please Indicate below how you would like to contacted: Very occasionally we may send you promotional material (e.g. vaccine amnesty information). This will be no more than one or two times a year. We always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Please Indicate below how you would like to contacted: Text Email Post No thank you