Gilmer Park Animal Clinic

60660 U.S. 31
South Bend, IN 46614

(574)291-3302

gilmerparkanimalclinic.com

Prescription Refills

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription medication or prescription diet by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

We will notify you via by phone when your pet's prescription is approved and ready to be picked up.   If you would prefer to have the prescription mailed to you, please mention this information in the additional information area (pre-payment via credit card is required for pescriptions to be mailed).

 

Prescription Refills Online

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
E-Mail Address (required) :
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Sex (required)
Male
Female


Age: Years, Months

Have we seen your pet within the last year?
Yes
No


Medication Refill Requested (required)

Additional Comments / Questions


Check the reCAPTCHA to ensure you are not a robot: