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(618) 533-3042
8220 Shattuc Road, Centralia, IL 62801
crookedcreekanimalhospital1@gmail.com
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Prescription Refill and Food Order Request Form
Please use the form below to request your prescription refill or food item. This will save you time when picking up your order. Please allow 24 hours for order processing. Do not come to the clinic until you have received confirmation to pick up your order.
Note: Some prescriptions will require an examination of your pet prior to re-filling.
Many prescriptions require your pet to be examined before dispensing. This ensures that your pet is healthy enough to handle the potential side effects of some prescriptions and provides further confirmation that the medication is appropriate for your pet’s current condition.
IMPORTANT: Prescription Refills and Food Orders are not confirmed until you have received notification. A staff member will contact you by phone or email.
Name
*
First
Last
Email
*
Phone
*
Pet Name
*
Drug or Food Name
*
Dosage/Size/Strength
*
Quantity
*
Additional Comments
*
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Home
About Us
Team
Promotions
Careers
Surgical Consent Form
New Clients
New Client Registration Form
Services
Wellness & Vaccination
Preventive Services
Medical Services
Surgical Services
Nutritional Counseling
Pet Supplies
Additional Services
Pet Health
Pet Health Library
How-To Videos
Pet Health Checker
Pet Food Recalls
Product Recalls
Pet Insurance
Payment Options
Pet Portal
Refill Requests
Pharmacy
Contact
Request Appointment
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