Welcome to medi-vet Animal Health

Pet Medications and Pet Supplies
Order Form

When to use this Order Form

  • When you feel uncomfortable about submitting your credit card information online using our shopping cart .  Just fill out the "Order Form" below, and then fax or mail it in. 
  • All information submitted will be kept confidential, including email address, and will never be divulged to a third party.
Email: Orders:  orders@medi-vet.com
Phone Orders:
Fax (orders, prescriptions):		 (800) 668-9698  (Local: 985-875-7533)
(800) 854-9647   (Local: 985-875-7530)
Postal address: Medi-Vet Animal Health
71345 Ellis Road
Covington, LA 70433

Personal Information

Name:
Email:
Billing Street Address:
Apt. or Suite:
City: 
State:    Zip/Postal Code: -
Country:

Home Phone (include area code): 
Work Phone (include area code):
 

Shipping to a Different Address?

Name (if different):
Address:
Apt. or Suite: 
City: 
State:       Zip/Postal Code:
Phone (include area code):

Pet Information
Please complete only if ordering any prescription medications
 Questions about filling prescriptions?

Pet's Name:Breed:
Pet's Name:Breed:

Veterinarian:
Hospital/Clinic:
Phone (include area code):

Products Ordered

Product ID

Description

Qty

Price

 Extension

Subtotal:

  Louisiana residents add 4% Sales Tax:     

Shipping Rates

Total:
Customer Status
 Repeat customer of Medi-Vet.com
 First time customer of Medi-Vet.com

Credit Card Information:

______________________________________________________________________________  exp date:_________

It's Easy to Order Prescription Medications

Written prescriptions: Fax to 1-800-640-3274

or, mail to:
Medi-Vet Animal Health
71345 Ellis Rd., Covington, LA 70433.
Prescription Phone line for Veterinarians: 1-800-668-9698
Additional information needed if not on Rx: Owner, pet's name, breed, sex
Veterinarian's name, phone number

The hospital/clinic will be notified on all prescription orders so that entry can be made in your pet's record and to assure the accuracy of the prescription for the safety of your pet.

Using Our Secure
Shopping Cart		 If you choose to order using the "Order" buttons on each product page, your information will be submitted in a save and secure, encrypted form. All personal information is entered on a secure server and kept confidential.  In respect to your privacy, your information, including email address, will never be divulged to a third party. Back To Top

medi-vet.com

71345 Ellis Road, Covington, LA 70433
Telephone: (800) 668-9698    Fax: (800) 854-9647
http://www.medi-vet.com

Questions?  info@medi-vet.com

Copyright © 2000 Medi-Vet Animal Health Care. All rights reserved.
Revised: February 27, 2007.