Vernon Hills Animal Hospital

1260 South Butterfield
Mundelein, IL 60060

(847)367-4070

www.vhah.com

Refill a prescription Form

Owner Name (required)
First Name (required)
Last Name (required)
Pet's Name (required)

Name of prescription drug/s you want refilled and strength (Example: Doxycycline 100 mg capsules), how many do you want (Example: #25), and current dose (Example: 1 capsule 3X a day) (required)

When would you like to pick up this prescription? (Please note that if you need a prescription ASAP, call us instead of filling out this form. We will do our best to accommodate you, but may not be able to fill it if the doctors are busy). (required)

We will notify you when your prescription is ready to be picked up. We can email you (please give us your email address) or text or phone you (please give us your preferred phone number). (required)

Please write any comments you have about this prescription here.


Verify the reCAPTCHA: