Prescription Refill Request

You may request a medication refill by calling the office directly or by submitting an online request below. Please allow at least 1 business day to process your refill request. All refill requests will be evaluated and approved by Dr. Heather, or an Animal Vision Center of Virginia team member, based on Dr. Heather’s written prescription in the patient file.

Please note: By law, we can only refill medications up to 1 year following the last examination date. Many conditions require more frequent evaluation for medication titration, and will be refilled up to the date of the recommended recheck evaluation.

SUBMIT REFILL REQUEST ONLINE

Owner Name:*
First Last
Email*
Phone Number*
Patient Name*
Patient Breed*
Name of Medication & Quantity Requested for Refill*
When my prescription is ready, I would like to*
- Pick it up from Animal Vision Center of Virginia - Virginia Beach (520 Constitution Dr)
- Pick it up from Animal Vision Center of Virginia - Chesapeake (228 Mt. Pleasant Rd)
- Pick it up from a pharmacy of my choosing
- Have my prescription mailed to my residence (note a $7 shipping fee and additional days* for delivery)
Pharmacy Name*
Pharmacy Phone Number*
Medication Mailing Address*
Street Address Address Line 2 City State ZIP Code

*At this time, USPS packages may require more time to be delivered due to limited transportation availability as a result of the ongoing COVID-19 impacts
Confirm Email Address for Payment Authorization*
Please confirm your email address in order to receive payment authorization. Our office will email this address a link so that payment for the prescription and shipping ($7) can be made securely online.
Electronic Signature*
Date
Date Format: MM slash DD slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

If you prefer, you may fill out our downloadable form (below), print, and fax to 757-932-9325