Repeat Prescription Request Form

Order Repeat Prescription

Please be specific in your order, examples are detailed below. If your pet requires more than one repeat prescription for multiple medications, please only fill one request form, with the medications clearly set out in the order below. If you require a written prescription, please contact the surgery directly.

Please provide the same name and address that you registered your pet under to avoid any delay in processing your pets’ prescription.

A few details about yourself:

Title*

First Name*

Last Name*

Address *

Postcode *

Pets Name *

Details about the medication your pet needs:

Name of Medication (eg Metacam or Prednisolone) *

Size of Medication(eg 32ml or 5mg) *

Dosage (eg 20kg dose once a day or 1 tablet once a day) *

Quantity (1 bottle or 30 tablets) *

Is there any other information we need to know? *

*Optional* Photo of medication: Upload jpg, png or gif (Max 2MB)

Your Information

Blacks Vets Ltd is part of Linnaeus Veterinary Limited. We will not share this information with other companies for their marketing purposes. For more details on how we use your information please see our privacy policy (https://www.mars.com/privacy-policy-us)

We may use your information to send you reminders about products and services you have already purchased from us by SMS, email or post. These may be sent when your pet is due for a vaccination, flea or worming treatment or when your pet is due for a check-up recommended by your vet.

The personal data submitted via this form will be retained only for the purpose of responding to your question or concern, and will not be used for marketing purposes.

You must be 16 years old or older to submit a form.

If you would like to receive these reminders please tick here: Yes

We would like to send you our newsletters and contact you about promotions which may be relevant to you by post, email and SMS. If you agree to being contacted in this way please tick the relevant boxes;