Prescription Request

As a convenience to our clients, we are pleased to offer on-line prescription refills. If your pet is currently a patient with the Eau Claire Animal Hospital please complete the following fields for prescription refill requests.

Has your pet been examined by a veterinarian at the Eau Claire Animal Hospital within the last 12 months? *
	Yes	No
Contact Information
Name *
Address *
City *
State, ZIP *
Phone Number *
E-mail Address
Pet Name *
Pet's current weight *
* Required fields

Flea & Tick Preventative
	Frontline Plus for Cats 8 weeks or older.	$69.00 for 6 doses
	Frontline Plus for Dogs & Puppies 8 weeks or older and up to 22 lbs.	$75.00 for 6 doses
	Frontline Plus for Dogs 23-44 lbs.	$81.00 for 6 doses
	Frontline Plus for Dogs 45-88 lbs.	$84.00 for 6 doses
	Frontline Plus for Dogs 89-132 lbs.	$85.50 for 6 doses
Frontline Plus coupon available only through your veterinarian. Buy 6 doses get 1 dose free.
Heartworm Preventative
	Heartgard Chewables for Cats 5 to 15 lbs.	$29.40 for 6 doses
	Heartgard Plus Chewables for Dogs up to 25 lbs.	$54.00 for 12 doses
	Heartgard Plus Chewables for Dogs 26-50 lbs.	$66.00 for 12 doses
	Heartgard Plus Chewables for Dogs 51-100 lbs.	$78.00 for 12 doses
Heartgard Plus rebate available only through your veterinarian. Buy 12 doses and receive a $5.00 rebate by mail.
	Iverhart Max chewable tablets for dogs 6.0 to 12 lbs.	$34.20 for 12 doses
	Iverhart Max chewable tablets for dogs 12.1 to 25 lbs.	$47.04 for 12 doses
	Iverhart Max chewable tablets for dogs 25.1 to 50 lbs.	$55.20 for 12 doses
	Iverhart Max chewable tablets for dogs 50.1 to 100 lbs.	$67.20 for 12 doses
Prices are subject to change.

Medication Refill Details
Medication Name *
Dosage *
Quantity *
Comments/Questions
Will you be picking up your pet's medication? *		Yes	No
When do you expect to pick up your pet's medication?		08/30/08 - Saturday 09/01/08 - Monday 09/02/08 - Tuesday 09/03/08 - Wednesday 09/04/08 - Thursday 09/05/08 - Friday
Would you like your pet's medication mailed to you? *		Yes	No
» Please allow 48 hours for us to review your pet's record and contact you with additional questions. » Blood work may be required prior to refilling some medications. » Postage and handling fees will apply. Prescriptions by mail will require credit card payment by phone.