Veterinary Eye Center, PLLC

3908A Far West Blvd
Austin, TX 78731

(512)255-8700

www.veteyecenter.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 by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

Please provide us with at least two business days for refill requests submitted online. If you need an urgent refill, call the hospital at (512) 255-8700 instead of using this online form.

If you would prefer to have the prescription mailed to you, please mention this information in the additional information area. For a mailed medication refill, please call our hospital at 512-255-8700 to obtain a credit card authorization form.

This form is to refill your medication at Veterinary Eye Center or have us submit a refill to the pharmacy.

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 Type	Phone Number (required)

Evening Phone
Phone Type	Phone Number

Pet's Name (required)

Have we seen your pet within the last year? (A physical exam within the last year is required for medication refills) (required)

Yes
No

Medication(s) Requested - List FULL names of drugs please (required)

Where do you want to pick up the medication? (required)

Veterinary Eye Center
Pharmacy

Additional Comments / Questions

Fill in this information only if you want the prescription filled at a pharmacy. Please ensure the pharmacy has the medication you want in stock before submitting this form to us.

Pharmacy Name

Pharmacy Phone Number

Pharmacy Fax Number

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Last updated March 14, 2023