Prescription request form

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am a registered client of Borris Veterinary Clinic *

We cannot issue prescriptions for unregistered clients. If you would like to register as a client please click here

Yes

Preferred method of contact for confirmation of prescription *

Email

Text

Telephone call

Medications Required

Flea treatment

Wormer

Combined flea & worm tablet (monthly)

Other*

Delivery *

Collect at Borris Veterinary Clinic

Delivery (free postage for orders over €50)

Payment *

Send me a payment link for online payment (required if you chose the delivery option)

Pay on collection