Special Rx Request

Where We Treat Your Pet Like Family!

MOKENA ANIMAL CLINIC 9455 W. 191st St. Mokena, Illinois 60448 Telephone: (708) 479-2811

Providing Full Service Veterinary Care for the entire Mokena, Illinois community since 1982

E-MAIL US

Special Rx Request

Phone Us At:

(708) 479-2811

Visit Our Online

PET GALLERY

Click Above

To Visit Our

Rainbow Bridge

Pet Memorial

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Welcome to the
ALL PET CENTER

If you can't find your Pet Prescription

in our Online Pet Pharmacy, just fill

out the Special Request Form below

and submit it online.

All pet prescriptions must be authorized by the Veterinarian. If the Veterinarian does not authorize your prescription, you will be notified via E-mail with instructions to make an appointment for your pet.

PLEASE NOTE: OUR ONLINE PET PHARMACY IS FOR PATIENTS OF MOKENA ANIMAL CLINIC ONLY

Pet's Name

Your Name

Your Address

City State Zip

Telephone Evenings

E-mail

Name of Medication

Dosage (mg., etc.) No of tablets/capsules, etc.

Is this a refill? Yes No

Comments of Questions for the Veterinarian:

Charge to which Credit Card? Expiration Date

Credit Card No:

Name on Card

Billing Address

City State Zip

The amount charged to your credit card will be sent to you via E-mail at the time your prescription is authorized.

Your card will not be charged until you send us a confirming E-mail to validate your purchase.

When we have received your confirmation E-mail, we will ship your prescription.

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