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Pet Prescription Form Template

Streamline Your Pet's Prescription Requests Effortlessly

Managing pet prescriptions can be overwhelming, especially when time is of the essence. This veterinary prescription template simplifies the process for veterinarians and pet owners alike, ensuring smooth communication and prompt service. By using this form, you can quickly receive prescription requests, keep accurate records, and enhance overall client satisfaction while ensuring compliance with necessary guidelines. It's designed for easy customization and integration with your existing workflow. Check out the live template to see how it works!

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Owner full name
Owner email
Owner phone number
Mailing address
Preferred contact method
Email
Phone call
Text message
No preference
Pet name
Species
Dog
Cat
Rabbit
Bird
Reptile
Small mammal
Other
Please Specify:
Breed
Sex
Female
Male
Unknown
Date of birth (or approximate)
Current weight (include unit)
Known drug or food allergies
Current medications and supplements
Spay/neuter status
Spayed/Neutered
Intact
Unknown
Prescribing veterinarian full name
Veterinary license number
Clinic or hospital name
Clinic phone
Clinic email
Clinic address
Patient relationship status
Existing client
New client
Telemedicine consult
Shelter/Rescue patient
Other
Please Specify:
Diagnosis or indication
Medication name
Strength or concentration (e.g., 50 mg tablet, 10 mg/mL)
Dose per administration (e.g., 1 tablet, 0.5 mL)
Route of administration
Oral
Topical
Otic (ear)
Ophthalmic (eye)
Injectable
Transdermal
Other
Please Specify:
Frequency
Once daily (every 24 hours)
Twice daily (every 12 hours)
Three times daily (every 8 hours)
Every 6 hours
Every 8 hours
Every 12 hours
As needed (PRN)
Other
Please Specify:
Duration of therapy
3 days
5 days
7 days
10 days
14 days
30 days
Until finished
Other
Please Specify:
Quantity to dispense
Refills authorized
0 (no refills)
1
2
3
4
5
Other
Please Specify:
Allow generic substitution
Yes
No
Is this a controlled medication?
Yes
No
Special instructions for owner or pharmacy
Flavor preference (if compounding is needed)
Chicken
Beef
Fish
Peanut butter
Unflavored
No preference
Not applicable
Pharmacy name
Pharmacy phone
Pharmacy email
Preferred fulfillment location
In-clinic pharmacy
External retail pharmacy
Online pharmacy
Compounding pharmacy
No preference
Send prescription via
Fax
Email
Electronic prescribing
Printed copy with owner
Pickup or delivery method
Owner pickup
Clinic pickup
Mail delivery
Courier
To be arranged
Pregnancy or lactation status (if applicable)
Not pregnant
Pregnant
Lactating
Unknown
Not applicable
History of adverse drug reactions
Is this prescription urgent?
Yes
No
I understand the dosing instructions and possible side effects
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Owner signature (print name)
Owner date signed
Prescriber signature (print name)
Prescriber date signed
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Paper art illustration showcasing a pet prescription form template for FormCreatorAI article

When to use this form

Use this form when you need to prescribe medication after an exam, telehealth visit, surgery, or for chronic care. This veterinary prescription template helps you capture weight-based dosing, contraindications, refills, and client consent in one place, so orders are clear and traceable. If you keep digital records, align details with the Veterinary EMR form to keep history, labs, and prescriptions in sync. When a dog's profile changes (age, weight, microchip), pair it with the Dog bio update form so doses reflect current data. You can also standardize preventive meds for heartworm, flea or tick control, and set reminders for follow-ups.

Must Ask Pet Prescription Questions

  1. What is your pet's species, breed, age, and current weight?

    Dosage and drug choice depend on species, breed sensitivities, age, and mg/kg weight. This prevents underdosing or toxicity and supports evidence-based dosing.

  2. What diagnosis and symptoms are you treating?

    Clear diagnosis and symptom notes guide the correct medication, route, and duration. It also sets a baseline to judge response at the follow-up.

  3. What medications and supplements is your pet taking, and any known allergies?

    This surfaces potential interactions and allergy risks before you issue or refill a drug. It reduces adverse events and avoids duplicating therapies.

  4. Which pharmacy should fill the prescription, and how should we handle pickup or delivery?

    Having pharmacy details, contact info, and preferences speeds dispensing and cuts back-and-forth. It also lets you include directions the pharmacist needs.

  5. Has the pet's ownership or contact information changed?

    Legal and controlled prescriptions must list the current responsible owner and contact details. If ownership changed, update records with the Transfer of dog ownership form so the script and records match.

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