Rx Special Request

Full Service Veterinary Care For Your Pets ~ EVERY Pet Is Special To Us!

GRANITE CITY PET HOSPITAL 2935 South 2nd Street St. Cloud, Minnesota 56301 Telephone Us At: 320-252-0277

E-MAIL US

Phone Us At:

(320) 252-0277

Visit Our Online

Pet Pharmacy

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is provided by our friends at

Animal House Magazine ~

Putting Pets Online!

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Welcome To
Granite City
Pet Hospital

If you can't find your Pet Prescription

in our Online Pet Pharmacy, just fill

out the Special Request Form below

and submit it online.

All pet prescriptions must be authorized by the Veterinarian. If the Veterinarian does not authorize your prescription, you will be notified via E-mail with instructions to make an appointment for your pet.

PLEASE NOTE: OUR ONLINE PET PHARMACY IS FOR PATIENTS OF GRANITE CITY PET HOSPITAL ONLY

Pet's Name

Your Name

Your Address

City State Zip

Telephone Evenings

E-mail

Name of Medication

Dosage (mg., etc.) No of tablets/capsules, etc.

Is this a refill? Yes No

Comments of Questions for the Veterinarian:

Charge to which Credit Card? Expiration Date

Credit Card No:

Name on Card

Billing Address

City State Zip

The amount charged to your credit card will be sent to you via E-mail at the time your prescription is authorized.

Your card will not be charged until you send us a confirming E-mail to validate your purchase.

When we have received your confirmation E-mail, we will ship your prescription.

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