Farm Animal/Equine




 Customer Name                    Invoice Address                        Delivery Address



 Order Date



Medicine Name Pack Size Quantity Dosage Instructions Animal Type &
Withdrawal Times








No. Repeats

Type:

Milk:

Meat:








No. Repeats

Type:

Milk:

Meat:








No. Repeats

Type:

Milk:

Meat:








No. Repeats

Type:

Milk:

Meat:
  
  
Presribing Veternary Surgeon
Name: Qualifications:
I declare that this prescription is for animals/an animal under my care
Name of Practice/Stamp:
Address (or stamp):
  
  
 
 
Signature: Date:

PRESCRIPTIONS ARE VALID FOR SIX MONTHS FROM THE DATE OF PRESCRIBING

The medicines can only be dispensed once we have received the
original copy signed by your Veterinary Surgeon.

FOR OFFICE USE ONLY:
Validated ____/____/____      Validated By ____________      Rx Expiry ____/____/____