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Flea Control & Wormers
Flea Control & Wormers
A few details about yourself:
Surname
*
Contact Telephone Number
*
House No./Name
*
Address Line 1
*
Email
*
From which surgery they would like to collect the items?
*
- Select your preferred surgery -
Solihull
Bentley Heath
Acocks Green
A few details about your pet:
Pet's Name
*
Pet's Age
*
Species
*
- Please Select -
Cat
Dog
Rabbit
Other
Breed
*
Pet's Approx Weight (Kg)
*
Treatment
Choice of preparation
*
Choice of preparation
Flea Treatment
Worming Treatment
Both
For safety, are they using any other preparations purchased elsewhere?
*
For safety, are they using any other preparations purchased elsewhere?
Yes
No
For safety, are there any other species of animals or small children in contact?
*
For safety, are there any other species of animals or small children in contact?
Yes
No
Please state
If you have previously used this service, do you require the same treatment as before?
*
If you have previously used this service, do you require the same treatment as before?
Yes
No
Confirmation of Terms and Conditions
I accept that repeat prescriptions can only be prescribed by a vet upon the condition that my pet has received a health check for the condition(s) in line with the veterinary professions right to prescribe or dispense.
*
I accept that repeat prescription requests take up to two working days to process
*
I accept that all medication must be paid for upon collection and no credits or refunds can be given for unused medication once they have left the practice
*
Consent
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