Blue Oak Veterinary Hospital

125 Peek Street, Suite E
Jackson, CA 95642


Prescription Refill Form

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor. We will notify you via email or phone when your pet's prescription is approved and ready to be picked up. We will also inform you of the total cost of the prescription, and will request a credit card number by phone at that time. If you would prefer to have the prescription mailed to you, please mention this information in the additional information area.
Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Patient Information
Pet's Name (required)

Species (required)
Age: Years, Months (required)

Gender (required)
Male Neutered
Female Spayed
Have we seen your pet in the last year? (required)
Medication Requested (required)

Additional Comments/Questions (required)

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