727-934-0814	Dr Wesley Cochran DVM
1840 Alt. 19 South • Tarpon Springs, FL 34689 (Just North of Klosterman Road)

Refill Requests

Anclote Animal Hospital can only refill medications that were originally prescribed by one of our doctors, with an exam within the last 6 months. Please understand that this refill service is only to be used by current clients of Anclote Animal Hospital. Requests can be used for medications, flea and heartworm preventions and prescription diets. For canine heartworm medication, a current, negative heartworm test, with proof of monthly heartworm administration must be on record. Some prescriptions require bloodwork every six months.

Please call in for your refill: 727.934.0814


Client Name*
Patient Name*
Phone (# 1)*
Phone (# 2)
E-mail*
Street
City, State, Zip
Refill request information* **please be specific with all information.

Quantity
Date of last prescription
Doctor prescribed by	Dr Cochran Dr Duncan
How would you like us to contact you about your presciption's availability? *	Call Phone # 1 first Call Phone # 2 first E-mail
Additional Comments or Questions?

727-934-0814 1840 Alt. 19 South •• Tarpon Springs, FL 34689 (Just North of Klosterman Road)

Dr Wesley Cochran DVM

Refill Requests