Forms

Medication Request Form

You can request a refill of your pet’s medication or prescription diets to be ready for pick up at the hospital. Please note that 48 hours’ notice is needed to process this request.

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Medication & Prescription Pet Food Refill Request Form

Please complete the form with your information as it appears on your account.

NOTE: Requests will be checked Monday – Friday at 8 AM, 12 PM, and 6 PM, and on Saturday at 8 AM and 12 PM. We are closed on Sunday. Please allow up to 2 business days for your request to be processed.

If you need the medication or food sooner, please call the hospital directly at 717-733-2155. You can also visit Hill’s to Home for more pet food resources.

Please provide the information in the form as completely as possible. All information is strictly confidential.

Name *

First

Last

E-mail *

Confirm Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Pet's Name *

Medication/ Pet Food Name *

Medication Strength *

Quantity *

How are you currently giving this medication? *

Is this a change from the last prescription refill?

Do you have an additional medication request?

Additional Comments

Name

Forms

Medication Request Form

Medication & Prescription Pet Food Refill Request Form

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