*FIRST NAME:  
  *LAST NAME:  
  *ADDRESS LINE 1:  
  ADDRESS LINE 2:  
  *CITY:  
  *STATE / PROVINCE / REGION:  
  *ZIP / POSTAL CODE:  
  *PHONE NUMBER: (xxx xxx-xxxx)  
  *EMAIL:  
       
 

*HOW WOULD YOU LIKE TO RECEIVE THE PRESCRIPTION REFILL? PLEASE CHOOSE ONE:

  
       
 

*PLEASE ENTER MEDICATION NAME, QUANTITY REQUESTED AND CURRENT DOSAGE OF MEDICATION:

  
 

*DENOTES REQUIRED FIELDS.

  
 
 
  YOU MUST HAVE YOUR CREDIT CARD ON FILE AND UP TO DATE WITH NATURAL PET ANIMAL HOSPITAL TO UTILIZE THE ONLINE PRESCRIPTION SERVICE.

ONLY MEDICATIONS ORIGINALLY PRESCRIBED BY DR. KAREN BECKER WITHIN THE LAST YEAR ARE AVAILABLE FOR ONLINE REFILLS.

YOUR RECEIPT WILL BE INCLUDED IN THE SHIPMENT.

ALL ORDERS ARE PROCESSED THE NEXT BUSINESS DAY AND SHIPPED VIA US POSTAL SERVICE PRIORITY MAIL. (2-3 DAYS IN TRANSIT) SO PLEASE ALLOW TIME FOR DELIVERY.

CURRENTLY A $6.00 FLAT RATE SHIPPING FEE WILL APPLY FOR MOST ORDERS PLUS AN ADDITIONAL $3.00 FOR ALL PACKAGES MAILED THAT REQUIRE COLD PACKS!