Town and Country Animal Hospital

Client Name:

Client Phone Number:

Alternative Phone Number:

Pet's Name:

Name Of Medication To Be Refilled:

Quantity To Be Refilled:

Current Dosage Given:

Any Side Effects Seen?

Yes

Date Of Pet's Most Recent Exam:

Additional Comments:

Please note: We make every effort to meet the needs of our patients. Certain medications require close monitoring during use for your pet's safety.

Please Allow 24 To 48 Hours For Processing Of Your Request.

Monday

7:00 AM - 6:00 PM

Tuesday

7:00 AM - 6:00 PM

Wednesday

7:00 AM - 6:00 PM

Thursday

7:00 AM - 6:00 PM

Friday

7:00 AM - 6:00 PM

Saturday

8:00 AM - 1:00 PM

Sunday

Closed

For after hours emergency care (336) 227-9979 or for emergencies after 11 PM : (336) 632-0605