Medication & Supplement Form

Name*
Email Address*
Phone Number
Pet Name*
Medication & Supplement List
Name of medication What is the medication used for? How much? How often? AM/PM
Do your instructions match the label(s) on the bottle(s)?*
- Yes
- No
Any special way to administer medication(s)?*
- Yes
- No
If yes, please describe.
Any medication(s) that must be refilled if we run out?*
- Yes
- No
If yes, please list the medications.
Please tell us anything else we need to know.
CBD OIL Purchase Only:
The Food and Drug Administration has not evaluated these statements and this product is not intended to diagnose, treat, cure, or prevent any disease. This is an off label use in our pets.
- I acknowledge.
Comments
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Funny Farm
Petcare + Nutrition

Name of medication	What is the medication used for?	How much?	How often? AM/PM