Repeat Prescriptions

This form should be used to request medication which your horse has had previously. Please complete as many of these details as possible.

Your Details
Name:
Address:
City/Town:
County:
Post Code:
Contact Tel:
Email:

Please tick here if you would like us to use your email address for future mailings.

About Your Horse
Name:

About the drugs you are requesting
Drug Required:
Size (e.g. 10mg tablets or sachets):
Amount Required:
What dose are you currently using:
Name of Vet who last treated the horse:
When did you last use this medication:
How much have you got left:
How would you like us to get them to you:
Any other information that may be useful to us:

	Copyright WCEC 2007