Rx Refill

Montesano & Tallarico, D.V.M., LLP

305 Old Willets Path
Smithtown, NY 11787

(631)366-0003

montallequine.com

Prescription Refills

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your horses's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

We will notify you via email or phone when your horses's prescription is approved and ready to be picked up. We will also inform you of the total cost of the prescription, and will request a credit card number by phone at that time. If you would prefer to have the prescription mailed/delivered to you, please mention this information in the additional information area.

Prescription Refills Online

Name (required)

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

E-Mail Address (required) :

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

Horses Location (if different from above)
Street Address

City ,	State / Province	Zip / Postal Code

Horse's Name (required)

Sex (required)

Stallion
Mare
Gelding

Age: (required)

Have we seen your horse within the last year?
Yes
No

Medication/Product Requested (required)

Additional Comments / Questions

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631-366-0003

Montesano & Tallarico, D.V.M., LLP

Prescription Refills

Prescription Refills Online