Copyright 2010 Tehachapi's Premier Place for Pets: Tehachapi Animal Care. All Rights Reserved.

Tehachapi Veterinary Hospital

20693 Woodford-Tehachapi Road

Tehachapi, CA 93561                          

Veterinary Hospital  -- 661-822-6731

Please submit this form and we will be happy to have your pet's prescription medications or food ready for you when you come by.  Let us know how to contact you once your prescription is ready.  We can also mail the medication to you if this is more convenient.

Your full name:

Your pet's name:

I am requesting a refill for:

Name of medication or food to refill:

This number is:

My Contact Number:

Are you interested in having your pet's medications mailed to you?

Please let us know how your pet is doing:

Regarding this refill:

I would like to change my prescription:

Check this box if you would like to be contacted regarding any questions you have about this medication

When my prescription is completed:.

My DogMy Cat

Home PhoneCell PhoneE-mail Text

Please contact meI am not interested in having my medication mailed

My pet is doing very well on these medicationsNo significant change noted - will continue to use medications at current dosesI have noticed some limited improvement since using these medicationsMy pet is not doing well, please have someone call me to discuss potential further options

Refill medication (or food) exactly as before (same quantity, etc)I would like to change the amount of medication or food (tell us your requested changes below)

Please call me at my contact number belowDo not contact me - I will pick up the medication (please allow 24 hours)