Conestoga Animal Hospital

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 Mon. – Fri. at 8 a.m., 12 p.m., & 6 p.m.; Sat. at 8 a.m. & 12p.m.; Sun. – Closed. Please allow up to 2 business days for your request to be processed.

"*" indicates required fields

Name*

First Last

Email*

Enter Email Confirm Email

Address*

Street Address 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?

Yes

Do you have an additional medication request?

Yes

If yes, submit your request

Additional Comments

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 hour notice is needed in order to process this request.

If you need the medication or food sooner, please call the hospital directly at 717-733-2155.

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

Pet Food Website Resources

Visit:
www.hillstohome.com