# 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.

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.

Canonical: https://reuily.com/templates/pet-medication-refill-request
Use this template: https://reuily.com/form/from-template/pet-medication-refill-request
Collections: Requests & Intake, Pets & Animals, Veterinary Clinics
Last updated: 2026-10-24

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What's your phone number? (Phone, required)
- Question 4: What's your pet's name? (Short Text, required)
- Question 5: Which medication do you need refilled? (Short Text, required)
- Question 6: What dose does your pet take? (Short Text, required)
- Question 7: How many days of medication are left? (Single Choice, required). Options: None left; 1 to 3 days; 4 to 7 days; More than a week
- Question 8: Has anything changed since your pet's last visit? (Long Text, optional)
- Question 9: How would you like to get the refill? (Single Choice, required). Options: Pick up at the clinic; Send to an outside pharmacy; Ship from your online pharmacy
- Question 10: Which pharmacy should we send it to? (Short Text, optional)
- Question 11: Upload a photo of the label (File, optional)

## 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

## 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.