RX Refill - Formstack

To order and delivery from Pieper's online store, please CLICK HERE

For urgent refills please call the hospital

Which department is your pet seeing?*

Primary Care Location*

FOR PIEPER OLSON'S DRIVEWAY PICK-UP OF MEDICATIONS AND DIETS

Medication pick-up window hours:

Monday - Friday: 8 am - 7:30 pm
Saturday & Sunday: 8 am - 4:30 pm

For urgent refills please call the hospital at (860) 347-1122 and speak with one of our client service team members. Thank you.

Pieper Memorial Internal Medicine

(Pick up prescriptions at the window. Follow the driveway to the rear of the building)

Medication Pick-up Window Hours:

Monday - Friday: 8 am - 7:30 pm
Saturday & Sunday: 8 am - 4:30 pm

For urgent refills please call the hospital at (860) 347-1122 and speak with one of our client service team members. Thank you.

Pieper Memorial Avian & Exotics

(Pick up prescriptions at the window. Follow the driveway to the rear of the building)

Medication Pick-up Window Hours:

Monday - Friday: 8 am - 7:30 pm
Saturday & Sunday: 8 am - 4:30 pm

For urgent refills please call the hospital at (860) 347-1122 and speak with one of our client service team members. Thank you.

Pieper Memorial Oncology

(Pick up prescriptions at the window. Follow the driveway to the rear of the building)

Medication Pick-up Window Hours:

Monday - Friday: 8 am - 7:30 pm
Saturday & Sunday: 8 am - 4:30 pm

For urgent refills please call the hospital at (860) 347-1122 and speak with one of our client service team members. Thank you.

Pieper Memorial Surgery Department

(Pick up prescriptions at the window. Follow the driveway to the rear of the building)

Medication Pick-up Window Hours:

Monday - Friday: 8 am - 7:30 pm
Saturday & Sunday: 8 am - 4:30 pm

For urgent refills please call the hospital at (860) 347-1122 and speak with one of our client service team members. Thank you.

For our emergency patient all refill requests are processed through your primary care veterinarian. If you have spoken with them, and still need a refill, please give us a call at 860-347-8387. Thank you

For our neuro patient all refill requests are processed Monday - Friday. Refills submitted Friday afternoon will be complete on Monday. If you need an urgent refill please call us at 860-347-8387

No problem! Please continue to fill our the medication refill form and we will direct your request to the correct department.

Name*

First Name

Last Name

Primary Owner Date of Birth

Due to drug reporting for the state of Connecticut, we now require the date of birth for the primary contact

Pet's Name:*

Primary Phone*

Email

Medication Name:*

Medication Strength:

How much are you giving? And how often?

Where is this medication normally filled?*

At the hospital Outside Pharmacy Shipped to my house ($15 shipping fee)

Pick up will be at Pieper Olson - Entrance C (towards back of building), 730 Randolph Rd, Middletown, CT

Pick up will be at Pieper Olson - Entrance C (towards back of building), 730 Randolph Rd, Middletown, CT

Pick up will be at Marlborough Office Front Desk (212 East Hampton Rd, Marlborough, CT)

Pick up will be at Essex Office Front Desk (114 Westbrook Ave, Essex, CT)

Pick up will be at East Haddam Front Desk (105 Town St, East Haddam, CT)

Pick up will be at Pieper Veterinary Berlin St. Front Desk (150 Berlin St, Middletown, CT)

Pick up will be at Pieper Veterinary Stratford, Front Desk (95-1 Armory Rd., Stratford, CT)

Please note, once the medication is ready we will contact you to confirm address and collect payment.

Pharmacy Name & Location

Do you need another medication filled?

Yes No

Medication #2:*

Medication Strength:

How much are you giving? And how often?

Where is this medication normally filled?*

At the hospital Outside Pharmacy Shipped to my house ($15 shipping fee)

Pick up will be at Pieper Memorial Front Desk - Entrance A (730 Randolph Rd, Middletown, CT)

Pick up will be at Pieper Olson - Entrance C (towards back of building), 730 Randolph Rd, Middletown, CT

Pick up will be at Essex Office Front Desk (114 Westbrook Rd, Essex CT)

Pick up will be at Marlborough Office Front Desk (212 East Hampton Road Marlborough, CT)

Pick up will be at East Haddam Office Front Desk (105 Town St, East Haddam, CT)

Pick up will be at Middletown Veterinary Office Front Desk (150 Berlin St, Middletown, CT

Pick up will be at Pieper Veterinary Stratford, Front Desk (95-1 Armory Rd., Stratford, CT)

Please note, once the medication is ready we will contact you to confirm address and collect payment.

Pharmacy Name & Location

Do you need another medication filled?

Yes No

Medication #3:*

Medication Strength:

How much are you giving? And how often?

Where is this medication normally filled?*

At the hospital Outside Pharmacy Shipped to my house ($15 shipping fee)

Pick up will be at Pieper Memorial Front Desk - Entrance A (730 Randolph Rd, Middletown CT)

Pick up will be at Pieper Olson - Entrance C (towards back of building), 730 Randolph Rd, Middletown, CT

Pick up will be at Marlborough Office Front Desk (212 East Hampton Road Marlborough, CT)

Pick up will be at Essex Office Front Desk (114 Westbrook Rd, Essex, CT)

Pick up will be at East Haddam Office Front Desk (105 Town St, East Haddam, CT)

Pick up will be at Middletown Veterinary Office Front Desk (150 Berlin St Middletown, CT)

Pick up will be at Pieper Veterinary Stratford, Front Desk (95-1 Armory Rd., Stratford, CT)

Please note, once the medication is ready we will contact you to confirm address and collect payment.

Pharmacy Name & Location:

Do you need another medication filled?

Yes No

Medication #4:*

Medication #4 Strength:

How much are you giving? And how often?

Where is this medication normally filled?*

At the hospital Outside Pharmacy Shipped to my house ($7.50 shipping fee)

Pick up will be at the Pieper Memorial Front Desk - Entrance A (730 Randolph Rd, Middletown, CT)

Pick up will be at Pieper Olson - Entrance C (towards back of building), 730 Randolph Rd, Middletown, CT

Pick up will be at the Marlborough Front Desk (212 East Hampton Road Marlborough, CT)

Pick up will be at the Essex Office Front Desk (114 Westbrook Rd, Essex, CT)

Pick up will be at the East Haddam Office Front Desk (105 Town St, East Haddam, CT)

Pick up will be at the Pieper Veterinary Berlin St. Front Desk (150 Berlin St, Middletown, CT)

Pick up will be at Pieper Veterinary Stratford, Front Desk (95-1 Armory Rd., Stratford, CT)

Please note, once the medication is ready we will contact you to confirm address and collect payment.

Pharmacy Name & Location:

Additional comments for Pieper Veterinary pharmacy technician:

**Please note: Oncology is in the office Monday through Thursday, from ~8AM until ~5PM. Emails are not monitored outside of these hours.

A member of the Oncology Team will return messages within two business days. If your pet is experiencing a medical emergency please, contact the ER department at (860)-347-8387 or go directly to your primary care veterinarian.**

The Avian & Exotics department is in the office Wednesday through Saturday, from 8 am-5 pm, messages left for Avian & Exotics are checked during those hours. Replies and refill requests sent through this form can take 1-2 business days, so please direct any urgent questions or requests to (860) 347-8387.

Messages for the surgery service will be checked Monday - Friday during business hours, 8am - 5pm, and periodically on weekends.

Replies and refill requests sent through this form can take up to 1-2 days, so please direct any urgent questions or requests to (860) 347-8387.

Messages left for the Neurology service will be checked Monday - Friday during business hours, 8am - 4pm.

Replies and refill requests sent through this form can take up to 1-2 days, so please direct any urgent questions or requests to (860) 347-8387.

Messages for the Internal Medicine service will be checked Monday - Friday during business hours, 8am - 5pm, and periodically on weekends.

Replies and refill requests sent through this form can take up to 1-2 days, so please direct any urgent questions or requests to (860) 347-8387.

Messages for the Physical Therapy service will be checked Monday, Tuesday, Thursday, and Friday during business hours.

Replies and refill requests sent through this form can take up to 1-2 days, so please direct any urgent questions or requests to (860) 894-4909.

Terms*

I understand that all messages will be checked during business hours. Medication refills require 1-2 business days and you will be contacted when they are ready for pick up.