Coastal Valley Veterinary Services

PO Box 1015
Old Lyme, CT 06371

(860)867-6367

coastalvalleyvet.com

Prescription Refills

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

We will notify you via email or phone when your pet's prescription is approved. We will also inform you of the total cost of the prescription, and will request a credit card number by phone at that time. Your pet's prescription will be mailed to you via First Class Mail.

Prescription Refills Online

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
E-Mail Address (required) :
Daytime Phone
Phone TypePhone Number
Evening Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Sex (required)

Male
Female


Age: Years, Months

Have we seen your pet within the last year?

Yes
No


Medication Requested (required)

Additional Comments / Questions


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