Medication refill request form The Pet Hospitals
Please note, this form is for refills of your pet's existing medications only.
Please do NOT use this form for
heartworm, flea or tick prevention (Simparica Trio, Advantage Multi, Bravecto or Revolution). You will NOT hear back from us about picking up your preventions.
If we have seen your pet within the last year, please just stop by during normal business hours to purchase.
I have read the above message and understand
Owner's first and last name
Phone number on your account
Owner's email
Pet's name
Medication name
Do you need to request more than one medication for the above pet?
Yes
No
Medication name
Medication name
Medication name
Do you need to request medication for another patient?
Yes
No
Pet's name
Medication name
Medication name
Medication name
What location would you like to pick your meds up at?
Please select...
Collierville (18 S Byhalia Rd)
Germantown (9947 Wolf River Blvd)
Lakeland (3031 Canada Rd)
Poplar @ Massey (6300 Poplar Ave)
Houston Levee (1144 N Houston Levee Rd)
Downtown (660 Jefferson Ave)
Midtown (2651 Union Ave Extended)
How would you like to be contacted when its ready?
Please select...
Phone call
Text
If I have previously opted out of text messages before, The Pet Hospitals has my permission to opt me back in today
Yes
No
Phone number for the phone call when ready
Phone number for text message when ready
Please note our hours below
Monday - Friday 7am until 6pm All locations
Saturday & Sunday 8am-2pm at our Collierville, Lakeland, Poplar & Downtown locations only
Please note if you are filling this out on a Saturday or Sunday it will not be read until Monday. If this is a time sensitive medication request please call or request the refill via chat on our website.
I understand
If you need heartworm or flea prevention and we have seen your pet within the last year, you do not have to use this form or call us. Please just stop by during normal business hours.
Contact Information