PHONE (650) 325.5671 / FAX (650) 325-8163
8-6 M-F / 8-5 Sat / Closed Sun
1125 MERRILL STREET, MENLO PARK, CA 94025
MID-PENINSULA
ANIMAL HOSPITAL
About Us
Our Team
Adoptees
Art Gallery
Medical FAQs
Holistic
Boarding
RxRefill • Supplies • Diets
Rx Refill and Supplies Request Form

How does this work? Completion of this form will generate a Rx refill request in our office. These requests will be processed during regular business hours. Allow one full business day in most cases. This service is intended for clients who have an ongoing client-patient-doctor relationship with one of our veterinarians, where the pets status is stable.

This form may also be used for over-the-counter products such as flea control, shampoos, or special diets.

If there has been a change in your pets condition since the last office visit, call our office directly so we may process a more expedited request. If this is a new problem or it has been a while since it last occurred, please call our office to discuss the situation.
* Information required to process request
Animal Name
*
Client First Name
*
Client Last Name
*
Street Address
*
Requested Item(s)
*
Where can we reach you to notify you that the Rx is ready or if the Dr. has a question?
Contact Phone
*
Best Time To Call
Email
Pickup Time
AM PM
Doctors Name