Media Veterinary Hospital Prescription Request Form



THIS SERVICE IS FOR CLIENTS OF

MEDIA VETERINARY HOSPITAL ONLY
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Is this a Refill?
Same as Shipping


The amount charged to your credit card will be sent to you via E-mail
at the time the prescription is authorized.
Your card will not be charged until you send us a confirming E-mail to validate your purchase.
When we have received your confirmation E-mail, we will ship your prescription.

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