This form should be used to request medication which your horse has had previously. Please complete as many of these details as possible.

Name: Mr Mrs Ms Miss Dr

Address line 1:
Address line 2:
City/Town:
County:
Post Code:

Contact Tel:
Email:

Please tick here if you would like us to use your email address for future mailings.

Name:

Drug Required:
Size (e.g. 10mg tablets or sachets):
Amount Required:
What dose are you currently using:
Name of Vet who last treated the horse:
When did you last use this medication:
How much have you got left:
How would you like us to get them to you:

Any other information that may be useful to us: