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  4. Repeat Prescription Request Form

Repeat Prescription Request Form

A repeat prescription template — pet, medication and last check-up captured, so refills are processed safely and without a needless visit.

Description

Pets on long-term medication need reliable refills — and a form beats a voicemail every time. This captures exactly what’s needed to dispense a repeat safely: the pet, the medication and dose, and when the pet was last reviewed, so the vet can approve it or flag that a check-up is due first. It asks the essentials for a safe repeat: the medication name, strength and dose, how much is needed, and the date of the last check — because medication reviews aren’t red tape, they keep a pet on the right drug at the right dose. Collection or delivery preference finishes it off. Put it on your site so refill requests arrive clearly, not as half-remembered phone messages. Free, brandable, and it keeps long-term patients safely stocked with less back-and-forth.

Form fields

Everything the Repeat Prescription Request Form above collects — 10 fields, so you can see exactly what it captures before you make it your own.

Request a Repeat Prescription

  • Pet's name

    Short Answer Icon
    Short Answer
  • Medication name & strength

    Short Answer Icon
    Short Answer
  • Dose & how often

    Short Answer Icon
    Short Answer
  • Quantity needed

    Short Answer Icon
    Short Answer
  • Date of last check-up / review

    Date Icon
    Date
  • Collection or delivery?

    Single-Select Icon
    Single-Select
  • Anything else we should know?

    Long Answer Icon
    Long Answer
  • Your name

    Name Icon
    Name
  • Contact number

    Telephone Icon
    Telephone
  • Email address

    Email Icon
    Email
Use Template Arrow Right Icon

Template FAQs

Common questions about the Repeat Prescription Request Form — what it captures, when to use it, and how to make it your own.

How do I request a repeat prescription for my pet?

Give the pet’s details, the medication name, strength and dose, how much you need, and the date of the last check-up. The vet reviews it and either approves the repeat or advises that a review is due first.

Why does my pet need a check-up for repeats?

Because medication reviews keep your pet safe — making sure the drug and dose are still right as things change. Vets are required to reassess periodically before continuing a prescription; the form captures the last review date to manage this.

How long do repeat requests take?

Practices usually ask for a bit of notice — often a day or two — to review and dispense safely. The form lets you request ahead so you don’t run out.

Can I get my pet's medication delivered?

Depending on the practice — the form captures whether you’d prefer collection or delivery, and the practice will confirm what it offers.

Can I request a written prescription to buy elsewhere?

Often yes — you’re entitled to ask for a written prescription to purchase medication from another supplier. Note it on the form and the practice will advise on any prescription fee.

Is the request form free?

Yes — free with a Fun Forms account, fully customisable, and ready to embed or share as a link.