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Prescription Request Form

AUSTRALIAN Residents ONLY. Australian LAW requires that for a prescription to be supplied, the animal must have been physically examined by a veterinarian within the last year for the problem requiring treatment. The reqular vet must also supply us with an authority to prescribe. YVO requires your animal's vet records to be sent to us. All scripts require a consultation with our vets at a fee of A$59.95. Plus a script fee of $30. Supply of a prescription is at the vet's discretion. Consult refunds will not be provided.

Yes I Live In Australia *

Full Name *

Full Postal Address *

Post Code *

Country *

Phone *

Email *

Please provide name and email address of your regular veterinary clinic. *

What species is this question about? *

Animal Breed *

Name Of Animal *

Age of Animal *

Please Note Down Any Medications Your Animal Is Currently Taking. Include dose. *

What medications do you require a script for? *

Name & Email of Chemist *

I understand I need to book a consult @ $59.95 and a script fee of $30.00? *