Brookeside Veterinary Hospital ~ Full Service Animal Care Since 1972       

                                   3010 Warren Road, Ann Arbor, Michigan 48105      Telephone:  (734) 761-7523        

 

                             For All Your Pet Grooming & Pet Boarding Needs In Ann Arbor Contact Us

 

                                            Brookedale Pet Grooming & Pet Boarding     Telephone: (734) 761-2292         

 

If you can't find your Pet Prescription

in our Online Pet Pharmacy, just fill

out the Special Request Form below

and submit it online.

 

All pet prescriptions must be authorized by the Veterinarian.  If the Veterinarian does not authorize your prescription, you will be notified via E-mail with instructions to make an appointment for your pet.

 

 

 

 

PLEASE NOTE OUR PRESCRIPTION SERVICE IS FOR PATIENTS OF BROOKESIDE VETERINARY HOSPITAL ONLY.

BrookesideVeterinaryHospital

 

For VetStore Refills, please call the office at (734) 761-7523

 

Pet's Name   

 

Your Name   

 

Your Address   

 

City        State        Zip   

 

Telephone     Evenings

 

E-mail

 

Name of Medication   

 

Dosage (mg., etc.)        No of tablets/capsules, etc.

 

Is this a refill?    Yes    No

 

Comments of Questions for the Veterinarian:

 

 

Charge to which Credit Card?    Visa MasterCard Discover    Expiration Date   

 

Credit Card No:               

 

Name on Card   

 

Billing Address   

 

City        State        Zip   

 

All pet prescriptions must be authorized by the Veterinarian.  If the Veterinarian does not authorize

your prescription, you will be notified via E-mail with instructions to make an appointment for your pet.