Allivet
Prescription Form
8001 West 26th Ave, Suite 9, Hialeah, FL 33016
Telephone:(877) 500-9944(clinic personnel only please)           Fax: (877) 500-9950
Allivet offers only US FDA/EPA approved medications.
(For use only by a licensed veterinarian)

No Rx Orders From Idaho

Pet Owner:   Date:  
Address:   City:  
State:   Zip Code:  
Phone:   Pet:  
Breed:   Sex:  
Medi-Vet Order Number (if available):
 
Rx

 

 

 

Refill - 0 - 1 - 2 - 3 - 4 - 5 - 6 - PRN [   ] Label
 
Dx/Tx:   Hospital/Clinic:  
Signature:  
Veterinarian’s Name (print):

, DVM

DVM  License:  
Phone: Fax:
How to use this form:
  1. Print and hand this form to your veterinarian for their convenience.  If you already have a completed prescription from your veterinarian, you can send that form instead.
  2. Then either fax, send by email attachment, or mail the prescription to us. 
  3. All prescription information will be verified with the hospital/clinic for the safety of your pet and to ensure accuracy of the Rx.
  4. Sending in only the prescription without an order does not constitute an order.  An order must also be submitted either by phone or it can be placed online.

Click here to print this form

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