Prescription Request Form – Hillside Veterinary Hospital

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Client name on file:*
First Last
Client Phone # on file:*
Pet's Name:
Drug:
Drug Strength:
Quantity Requested:
How often are you giving this medication (frequency):
How is your pet doing?
When do you need this medication by?
Do you have an additional prescription request?*
- Yes
- No
Prescription Request #2
Drug:
Drug Strength:
Quantity Requested:
How often are you giving this medication (frequency):
When do you need this medication by?
Do you have a third prescription request?
- Yes
- No
Prescription Request #3
Drug:
Drug Strength:
Quantity Requested:
How often are you giving this medication (frequency):
Do you have a third prescription request?
- Yes
- No
*Please note - due to high demand, orders may take longer than usual to arrive. We can not guarantee a pick-up date.
Comments

Contact our team today with any questions, or to book an appointment.

1700 Kings Road
Victoria, BC V8R 2P1

Ph: 250-598-4477
Fax: 250-598-7740

Mon: 8 am – 8 pm
Tue: 8 am – 8 pm
Wed: 8 am – 8 pm
Thur: 8 am – 8 pm
Fri: 8 am – 7 pm
Sat: 8 am – 7 pm
Sun: 9 am – 5 pm

Prescription Request #2