Prescription Request

For refills of an existing prescription. A SmartyVets veterinarian reviews every request before anything is dispensed.

Your details

Your name *

Email *

Phone *

Shipping address *

Your pet

Pet name *

Species *

Breed

Sex / reproductive status

Age / date of birth

Current weight (lbs) *

Needed for correct dosing.

The medication

Medication requested *

Strength / dose

Quantity requested *

Date last filled

Reason / diagnosis

Your veterinarian

Prescribing vet name *

Clinic name *

Clinic phone *

We may call to verify your prescription.

Date of your pet's last exam *

Health check

Any new health changes?

Other current medications

Known allergies / adverse reactions

Documents & sign-off

Upload prescription or records (optional)

PDF, JPG or PNG.

I confirm the information above is accurate, that my pet has been examined by the veterinarian named above, and I authorize SmartyVets to verify this prescription with that clinic. I understand medication is dispensed only after veterinary review. *

Type your full name to sign *