Prescription Request Form For controlled medications, please contact the pharmacy directly at (866) 784-6915​ Step 1 of 3 - Medication Information 0% Compounding Medications Medications Strength Dosage Form Flavor Quantity Price Refills Directions for Use Actions Edit Delete There are no Medications. Add Medication Maximum number of medications reached. Comments Client Name(Required) Client Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Sorry! At the moment, we are not shipping to your region.Client Phone Number(Required) Client Email(Required) Prescriber Name(Required)Select Prescriber NameDr. Emily AndersenDr. Heather MeyerDr. Kristan RileyDr. Wendy CrousePractice Name(Required) Prescriber Email(Required) License Number(Required) License State(Required) Phone Number(Required) Street Address(Required) City(Required) State(Required) Zip Code(Required) Signature(Required) Reset signature Signature locked. Reset to sign again January 18, 2025 7:41 am CSTBilling/Shipping(Required) Bill practice and ship to client Bill and ship to client PetScript will be contacting the client for payment.Consent(Required) By checking this box, I am authorized to execute this order and understand that use of the product will be conducted in accordance with applicable law. I have also reviewed this information and approve this prescription on rxpetscript.com from PetScript ProLab Pharmacy. Would you rather fax it in? Download Form Need Office Use Meds? Shop Now PetScript Pharmacy 3020 Lamar Ave, Paris, TX, 75460 Phone: 866-784-6915 | Fax: 903-785-1357 Email: [email protected] Privacy Policy | Disclaimer