Peter Morgan Pharmacy
High Street
Dyserth
Denbighshire
LL18 6AA
telephone or fax: 01745
570232
VETERINARY PRESCRIPTION
CLIENT INFORMATION
Name:………………………………………………………………………………………………………………………………
Address:…………………………………………………………………………………………………………………………
…………………………………………………………………………………………Post
Code…………………….………
Tel
No: ……………………………………… Mobile No:………………………Fax No:…………………………
Contact
Name…………………………………………….e-mail:……………………………………………………
|
Quantity
& Pack |
Product
(Brand or Generic) |
Dosage
Instructions
No of Repeats: |
Animal
or Herd |
|
Quantity
& Pack |
Product
(Brand or Generic) |
Dosage
Instructions
No of Repeats: |
Animal
or Herd |
PRESCRIBING VETERINARY SURGEON
Name:…………………….………………………………Qualifications:……………………………………………
Name
of Practice:…………………………………………………………………………………………………………
This prescription is for an animal or animals under my care
Signed……………………………………………………………………….Date……………………………………………
The medicines can only be despatched once we have received the original copy
signed by your Veterinary Surgeon