Owner Information * = required field

Pet Information - Medication Needed * = required field

Pet's Name *

Dog

Cat

Medication Name *

Size and Strength * as written on label

Quantity (QTY) *

Directions as written on label *
EXAMPLE: GIVE ONE TABLET TWICE A DAY
 

Any additional Comments may be
left in this text box (write as much as you need)

Payment Information * = required field

Pick-up or Mail Medication *

Pick-up at GFAH

Mail to me

If you want your medication mailed directly to you (at the address listed above) there is a $6.78 shipping fee and any applicable sales tax.

For direct mailing credit card information is required. Please fill out the info below if you want your pet's medication sent directly to you.

You will be contacted at the number provided above if there are any problems with the transaction.

If you have decided to pick-up your pet's medication please allow 24 hours after submitting this form for the request to be processed.
 

Name on credit card

Type of card

Visa® Mastercard® Care Credit™

Credit Card Number

Expiration Date

I agree to pay the $5.95 shipping fee
(only applicable if mailing)

YES

Would you like to be called or e-mailed with
a total prior to charging?

Call me E-mail me No Thanks

Greens Fork Animal Hospital does not ship controlled substances. i.e. torbutrol, phenobarbitol, diazapam among others.
If there is a problem processing your order you will be contacted using the phone number provided above, if a valid phone number
is not provided there will be a delay in receiving your pet's medication.