Medication Supply Request "*" indicates required fields 1Instructions2Personal Details3Medication Details4Medication 2 Details5Medication 3 Details6Dispensing Details7Confirmation Whilst our vets try to ensure that you are supplied with sufficient medication to last until your pet’s next review, occasionally you may find yourself short on medication supply for various reasons. We have tried to make this process more streamlined and accurate by creating this Medication Supply Request form. It is very important that you do not discontinue certain medications abruptly. Therefore we request that you fill out this form AT LEAST 2 WEEKS before you expect to completely run out of any of your pet’s medication. This is because it can take us up to 72 hours to process your request, and we also need to account for other factors outside of our control, such as postage delays and pharmacy processing times. The process: Fill out and submit one form per pet. Once you click ‘Submit’, this form will be emailed to both our admin team and your behaviour veterinarian for review and authorisation. You will also receive a copy for your records. One of our team will contact you by phone or email within the next 72 business hours (usually sooner!) to confirm your request and take your payment over the phone. We will attempt to contact you twice within this time, so please ensure that you are available to avoid delays. Please also have your calendar handy, as we may confirm your next appointment at this time. Once payment is made, your medication will be packaged and posted. Payments for postage must be finalised by 2:30pm if it is urgent and needs to be dispatched to the Post Office on the same day (Urgent Fees may apply). In the case of written scripts, your behaviour veterinarian will write and send out your script as soon as they are out of consultations with other clients. If your request for more medication cannot be completed (for example, because your pet is overdue for a review or not doing well), we will discuss this with you over the phone or by email and offer you alternative options. As mentioned above, please have your calendar handy in case we need to book in an appointment. Client DetailsClient Name* First Last Best Contact Number*Time you are available to be contacted between 9am-5:30pm Email* Patient DetailsProvide details for ONE patient only. If you require medication for additional patients you will have the option to complete additional forms after submitting this one.Patient Name* Usual Vet*[Select One]Dr Joanna McLachlanDr Sabine WilkinsDr Diana SoProgress*How is your pet progressing with the medication and overall plan?Observed Problems*Are there any problems that you would like to report with the patient's medication, including side effects or dosing problems? Medication DetailsMedication Name* Concentration*unit*[Select One]Milligrams (mg)Micrograms (µg)per*[Select One]TabletCapsulemLmL (transdermal cream)DoseHow much do you give the patient each time?Dose Amount*Dose type*[Select One]Tablet(s)Capsule(s)mLmeasured click (transdermal cream)FrequencyHow often do you give each dose?Frequency (once/twice/3 times)* Period*[Select One]a daya weeka monthas neededRemaining Medication (days)*How many days' worth of medication do you have left?Dispensing DetailsFulfillment 1*How would you like your medication to be filled? PLEASE NOTE: THESE OPTIONS HAVE RECENTLY CHANGED DUE TO A CHANGE IN LEGISLATION- we are no longer able to send digital scripts to your usual pharmacy unless in an emergency PBV to post medication to me directly (does not apply to compounded medication) Prescription posted to me (which I will take to my pharmacy) Prescription sent directly to pharmacy (note: only available for Pharmacy for Real or Compounding 4 Vet) I'm not sure- please talk me through my options Additional MedicationsAdditional Medications 1 Request additional medications for THIS patient?For additional patients, please submit a SEPARATE Medication Supply Request form. Medication 2 DetailsMedication Name* Concentration*unit*[Select One]Milligrams (mg)Micrograms (µg)per*[Select One]TabletCapsulemLmL (transdermal cream)DoseHow much do you give the patient each time?Dose Amount*Dose Type*[Select One]Tablet(s)Capsule(s)mLmeasured click (transdermal cream)FrequencyHow often do you give each dose?Frequency (once/twice/3 times)* Period*[Select One]a daya weeka monthas neededRemaining Medication (days)*How many days' worth of medication do you have left?Dispensing DetailsFulfillment 2*How would you like your medication to be filled? PLEASE NOTE: THESE OPTIONS HAVE RECENTLY CHANGED DUE TO A CHANGE IN LEGISLATION- we are no longer able to send digital scripts to your usual pharmacy unless in an emergency PBV to post medication to me directly (does not apply to compounded medication) Prescription posted to me (which I will take to my pharmacy) Prescription sent directly to pharmacy (note: only available for Pharmacy for Real or Compounding 4 Vet) I'm not sure- please talk me through my options Additional MedicationsAdditional Medications 2 Request additional medications for THIS patient?For additional patients, please submit a SEPARATE Medication Supply Request form. Medication 3 DetailsMedication Name* Concentration*unit*[Select One]Milligrams (mg)Micrograms (µg)per*[Select One]TabletCapsulemLmL (transdermal cream)DoseHow much do you give the patient each time?Dose Amount*Dose Type*[Select One]Tablet(s)Capsule(s)mLmeasured click (transdermal cream)FrequencyHow often do you give each dose?Frequency (once/twice/3 times)* Period*[Select One]a daya weeka monthas neededRemaining Medication (days)*How many days' worth of medication do you have left?Dispensing DetailsFulfillment 3*How would you like your medication to be filled? PLEASE NOTE: THESE OPTIONS HAVE RECENTLY CHANGED DUE TO A CHANGE IN LEGISLATION- we are no longer able to send digital scripts to your usual pharmacy unless in an emergency. PBV to post medication to me directly (does not apply to compounded medication) Prescription posted to me (which I will take to my pharmacy) Prescription sent directly to pharmacy (note: only available for Pharmacy for Real or Compounding 4 Vet) I'm not sure- please talk me through my options Additional MedicationsIf additional medications are required for this patient, please complete an additional form after submitting. Postage DetailsNote: Standard Australia Post delivery durations apply in addition to Pet Behaviour Vet processing times. We recommend selecting the "Express Post" option for faster fulfilment.Postage Method*If you selected 'PBV to post medication or prescription directly to me', which address are we posting the medication or script to? Australia Post - Parcel Post Australia Post - Express Post (additional fees apply) Address* Street Address Address Line 2 City New South WalesQueenslandVictoriaAustralian Capital TerritoryTasmaniaSouth AustraliaNorthern TerritoryWestern Australia State/Territory Postcode Pharmacy DetailsIf you selected 'Prescription sent to my pharmacy', which pharmacy are we sending your medication to?Pharmacy Name* Pharmacy Suburb* Special Instructions Confirmation* I have checked the medication name and doses carefully, and confirm that the provided information is correct.** I understand that submitting this form does NOT automatically mean that my request for more medication will be authorised, or sent.** I understand that payment over the phone is required before I am posted any medication or send any scripts.** I understand that Pet Behaviour Vet cannot be held liable in any way if Australia Post loses my package.** I am contactable within the next 72 business hours on the phone number or email address provided above. Delays may ensue if I am not contactable in this time.** I understand that Medication Authorisation Requests take time to process. An Urgent/Rush Fee of $10 may be charged for any medication requests that need to be urgently finalised within the next 24hrs.* Δ
