Equine Repeat Prescription form:

Please use this form to request a repeat prescription for medication that your horse/pony is using on a long-term basis. Please note that we are only able to prescribe for “animals under our care”. In order to fulfil this requirement we must see your horse/pony at least once every six months.

Name:*

Address 1:*

Address 2:

Town:*

Postcode:*

Home Tel:*

Mobile:

Email:*

Horse / Pony Information:

Name:*

Size: (hh)

Animal Age:

Prescription Information:

Drug Required: *

Size: (e.g 50mg tablet) *

Amount Required: *

What dose are you currently giving?

How much have you got left?

Delivery Information:

Did you want us to post the prescription, or are you going to pick it up from the surgery?:

  I would like my prescription posted (we are only able to post to the address registered on your account)

  I will pick it up from the surgery

When do you need the prescription by? (dd/mm/yyyy)

Any other information that may be useful to us (e.g. how is your pet doing on the medication?):