(770) 433-1414

PLEASE NOTE:

• This service is for REFILLS only. Although we will attempt to fill your pet's prescription promptly, this service may take up to 24 hours. Please contact our office by phone if your request is more urgent.
• Depending on the condition your pet has and the possible complications arising from certain medications, your pet may need to be checked before a refill can be given. If this is the case, you will be notified.
• Your will receive an E-mail once your prescription has been filled. We will not guarantee that your pet's medication is ready until you have received this E-mail. If this does not occur within 24 hours, please call our office at (770)433-1414.

Please give us your information:

Your name:

Your daytime telephone number:

Your E-mail address:

Please give us information for refill #1:

Pet's Name:

Name of medication:

Quantity you are requesting:

Additional Comments:

Please give us information for refill #2:

Pet's Name:

Name of medication:

Quantity you are requesting:

Additional Comments:

Note:
* This form requires Internet Explorer and will attempt to send an e-mail through your configured e-mail system. You must allow it to do so.
* You will NOT receive an acknowledgment once the form has been sent. * Once the form has been submitted you may click on another page on the menu or close this window.
AOL Users: Do not click the submit button. After filling out this form you must copy and paste this page into a new email and send it to: FrontDesk@cumberlandanimalclinic.com

REMEMBER: You must receive a confirmation E-mail before assuming your prescription has been filled.