Request a Prescription Refill

PLEASE NOTE:

• If it is more than 3 months since your last appointment at WAVES, you may need to schedule a consult before your medication can be refilled.  
• Please allow a minimum of 48 hours (2 business days) to complete your request. If the information below is incomplete, fulfillment may be delayed.  
• If you have run out of medication and this is now an emergency, please contact client services by calling 778-432-4322 for more information.
  

Contact Us

Today's Date *

CLIENT INFORMATION

Owner's Name *

First

Last

Phone Number *

PATIENT INFORMATION

Pet's Name *

Species *SELECT ONEDOGCAT

Age/Date of Birth *

PATIENT HISTORY

When was pet last seen by this hospital?

If it is more than 3 months since your last appointment at WAVES, you may need to schedule a consult before your medication can be refilled.

Which department prescribed it in the past? *SELECT ONEINTERNAL MEDICINENEUROLOGYSURGERY

Notes:

Did you try to get it refilled at your regular veterinary clinic? *SELECT ONEYESNOI DON'T KNOW

Notes:

How is pet's overall health since last visit? *SELECT ONESAMEWORSEBETTER

Notes:

Has it been prescribed here before? *SELECT ONEYESNOI DON'T KNOW

Notes:

Is the medication helping? *SELECT ONEYESNOI DON'T KNOW

Notes:

REQUESTED REFILLS

Are you refilling more than one medication? *

• Yes
• No

Medication Refill(s)

Layout

Medication

Medication

Medication

Dosage Remaining

Dosage Remaining

Dosage Remaining

Amount Requested (e.g. 30 days)

Amount Requested

Amount Requested

Medication Strength

Medication Strength

Medication Strength

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