Please complete the following form to request a prescription in its entirety. Please note that requests may take up to 72 hours. A representative from BVNS will contact you to confirm receipt of your request.
Contact Information
Select a title Mr.Mrs.Ms.
Your Name
Your Phone
Your Email
Patient’s Name
Select a BVNS Location to Contact Atlanta - 7800 Highway 92, Woodstock, GALeesburg -165 Fort Evans Road, NE, Leesburg, VA 20176Springfield - 6651 Backlick Road, Springfield, VA 22150Richmond - 5918 West Broad Street, Richmond, VA 23230Rockville - 1 Taft Court, Rockville, MD 20850
Select your Neurologist Dr. AkinDr. BarkerDr. BensfieldDr. BushDr. ChenDr. CuffDr. HigginbothamDr. JarboeDr. LamyDr. NearyDr. RiveraDr. TrubDr. WoodDr. Young
Prescription Request
Name of Drug*:
Strength (i.e. 100mg)*:
Amount/Dose (i.e. 2, every 2 hours)*:
Date Needed*:
How would you like to obtain your prescription*? Pick-up at local BVNS Call In to local Pharmacy Pharmacy Name Pharmacy Phone
Ship to your home Street Address City, State, Zip Code
Please provide an accurate list of your pet's medications including the prescription strength and current dose.
Please provide an update on your pet below
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