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Please mail your original, written prescription to:
VetRxDirect, 1900 James St, Ste 11, Coralville, IA 52241.

’s Species / Breed

’s Sex

Male

Female

Is your Spayed/Neutered?

Yes

Veterinarian’s Name (First and Last)

Clinic’s Street Name
This helps us identify your clinic and veterinarian

Clinic’s Phone Number

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