Written Prescriptions | The Ealing Vet

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Written Prescription Request

At The Ealing Vet, we are happy to provide you with a written prescription for your pet's chronic medication or parasite prevention, allowing you to buy the products online. Please ensure that you have read through the below information before requesting a written prescription.

Written Prescription T&Cs

Has your pet had a consultation with The Ealing Vet within the last 6 months*

Yes

No

My pet is currently well and I have no concerns*

Yes

No

My pet is over 12 months old*

Yes

No

I understand that this form is for ONE pet only. Submissions for other pets must be completed on a separate form.

I understand that this form is for ONE medication request only. Each medication request must have a separate form.

Date my pet was last examined in a consultation by The Ealing Vet*

*must be within the last 6 months

What type of medication are you requesting?*

Long term medication (e.g. for chronic illness)

Flea & Worming Medication (Parasite Control).

Please note that flea and worming treatments are typically sold online in fixed packs (most commonly as 3-month supplies). As a result, your vet will prescribe the maximum number of packs permitted within the legal prescribing period.

For example, if your pet is eligible for 11 months of treatment, we are only able to prescribe 3 packs of 3 months

For long term medication requests: In the last consultation with The Ealing Vet, we made an explicit agreement that my pet can be issued with a written prescription *

Yes

No

If you do not have an explicit agreement for written prescriptions, you will need to book a telephone consultation to discuss this, before proceeding

Client's First Name*

Client's Last Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Email Address*

Phone Number*

Patient Name*

Species*

Patient's up to date weight*

Medication Name*

Strength/Formula*

e.g 10mg

Medication Form*

Tablet

Capsule

Liquid

Spot-On

Other

Doseage*

The amount you give for each dose e.g. one tablet

Frequency*

Once Daily

Twice Daily

Three Times Daily

Other

Amount Requested*

What amount and how many repeats were permitted on your previous written prescription?

If you have had a written prescription previously, please upload it to support your request

I understand that all prescribed medication must be used before the prescription expiry date. Please note: If you do not use the full allocation within this time, a new prescription fee will be required.

Prescriptions are issued for an individual pet, and we will always provide the maximum amount we are legally able to prescribe. Controlled drug requests must be done with the vet and restrictions apply to allocations

I understand that once paid, the written prescription is dispensed under the discretion of the veterinary surgeon.

Prescriptions are:

Non refundable
Non negotiable
Non editable

*

I have read and checked that all of the details given are correct. I understand that the information given is final and that any changes after my prescription has been issued will result in a second written prescription fee.

I understand that if this form has been filled in incorrectly (e.g multiple pets and/or multiple medications included), my request will not be able to be processed

I have read and agree to the terms and conditions

Booking Request Form

The Ealing Vet Limited
07545 326 792
Company registration number: 16030888

Opening Hours:
Monday - Friday 07:30 - 17:30
Closed on bank holidays

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