Prescription Refill If PetScripts dispensed the original prescription and your veterinarian authorized refills, you can use this form to order a refill. Pet Owner's Contact Information Name* First Last Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Alternate PhoneEmail* We will confirm receipt of your order by email. Please make pet-scripts.com a "safe domain" in your e-mail's Junk E-Mail Protection, or check your Junk or Spam folder to find your confirmation. Prescription Information Find the prescription refill number in the top-left corner of your prescription label. RX #*Pet's Name*RX #Pet's NameRX #Pet's NameIf you have no refills left on your prescription, would you like us to contact your veterinarian? **If your prescription is has no refills, there may be a delay in the time needed to process your order***Select belowYes (There may be a 24-48 hour delay to process your order)No Delivery Information When we receive orders before noon, we can usually fill them the same day. How would you like to receive your refill?*Select belowPick up at the pharmacyShipped to me When would you like to pick up your refill? If you select Pick-Up, but do not specify a date and time, we will plan to have your order ready for pick-up by the following business day, in the afternoon. IMPORTANT: All prescription are custom made, so please allow 5 hours from the time of requesting a refill and picking it up. Thank you.Pick Up Date* Pick Up Time*9am10am11am12pm1pm2pm3pm4pm5pmPayment Information*Select belowCharge credit card on fileI will call with new credit card informationWill pay upon pick upPayment Information*Select belowCharge the credit card you have on file for meI will call with new credit card informationPlease select a shipping option below*Ship Standard U.S. Postal Priority Mail 1-4 days; usually one to two days for ME and NH $8.00 weekdays or $11.50 for perishables shipped over weekends and holidaysShip UPS Ground Guaranteed next business day for MOST of ME, MA, NH, VT, CT, RI Approximately $13.00 to $19.00 depending on weight and destination Ship Express Mail Guaranteed next day most places Approximately $25.00 – $35.00, depending on weight and destination Comments, Questions, or InstructionsIf you have any questions/comments, please list them below and we'll be in touch with you as soon as possible.Enter The Characters BelowPhoneThis field is for validation purposes and should be left unchanged.