Pet Medication Refill Request Template
A free pet medication refill request form for vet clinics. Owners request a prescription refill online, so your team stops taking refills by phone.
Customize the pages and design to fit your needs.
About this template
Owners share the pet, the medication and dose, how much is left and whether they'll pick up or want it sent to a pharmacy. Your team reviews each request in one list and calls when it's ready.
Common uses
- Vet clinics and animal hospitals
- Pets on long term medication
- Front desks taking refills by phone
Key features
- Medication, dose and days left
- Pickup or pharmacy choice
- Label photo upload
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
What's your pet's name?
Short Text
Which medication do you need refilled?
Short Text
What dose does your pet take?
Short Text
How many days of medication are left?
Single Choice · None left, 1 to 3 days, 4 to 7 days, More than a week
Has anything changed since your pet's last visit?
Long Text · Optional
How would you like to get the refill?
Single Choice · Pick up at the clinic, Send to an outside pharmacy, Ship from your online pharmacy
Which pharmacy should we send it to?
Short Text · Optional
Upload a photo of the label
File · Optional
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Frequently asked questions
What does a pet medication refill request ask?
The owner and pet, the medication and strength, the dose, how many days are left, any changes since the last visit and pickup or pharmacy.
Can I see which refills are urgent?
Yes. The days left answer shows who is running out, and you can send requests to Google Sheets to sort them.
Where should I put the refill form?
Link it from your website, your voicemail message and the label instructions, so owners stop waiting on hold to request a refill.