Fireworks/Thunderstorm Anxiety Medication Request

Please complete the form below to request a new prescription for anxiety medication. If this is a refill, please submit a refill request. Thank you! Please note that we can only prescribe medications for pets that are active clients at Walnut Creek Veterinary Clinic.

Fields marked with an asterisk (*) are required.

First Name*:

Last Name*:

Email:

Phone:

What behavior does your pet display during fireworks or storms? (i.e. hides, digs, chews on things)*

Besides medication, what have you already tried to help with your pet's stress level during fireworks or storms?*

Has your pet used sedatives before for fireworks or storms?*

Yes

Does your pet have a history of seizures?*

Yes

What medications is your pet currently on?*

Pet’s current weight in pounds*

Fireworks/Thunderstorm Anxiety Medication Request

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