Client Type: *

New Client
Existing Client

Name *

First

Last

Email *

Phone *

Address (if different from delivery address) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Preferred Method of Contact: *

Email
Phone

Emergency Contact *

First

Last

Emergency Contact Phone *

Name of Furry Family Member *

Requested Product *

Food
Prescription
Other

The Product Subscription Service is offered by Neighbourhood Pet Clinic as a way to make requesting, refilling, and receiving recurring prescriptions more convenient for our “neighbours”. However, all prescriptions are at the discretion of the veterinarian. As such, please note that Neighbourhood Pet Clinic has the right to refuse or adjust a prescription refill request at any time.

Please specify the name of your veterinary diet or contact our team for a nutritional recommendation *

Please specify the name of your prescription *

Please specify (ex. cat litter, toys, treats, etc.) *

Attach a photo of the product

Click or drag a file to this area to upload.

Frequency of Order *

If Other, please specify: *

If Unsure, please contact us for your product history and we can help make a recommendation.

What date would you like the subscription to start: *

If your request is urgent, please call us to set up your subscription.

Address for Delivery *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please Note: we only deliver to addresses within the City of London's limits. Product will be delivered on a weekday so we can deliver to home or work, whichever is most convenient.

Delivery Instructions/Buzzer Number *

After submitting the form, a team member will review the file and contact you to confirm your order, to collect your payment information over the phone, and to arrange a time to obtain a signature to authorize the recurring product charge (either in-clinic or the delivery driver can bring the form to you).

What is the best phone number for us to reach you to make these arrangements? *

I acknowledge that this is an enrollment for recurring product delivery and is not intended for one-time or urgent requests. By clicking "Submit", I confirm that my requested product is not needed in the next seven days. *

I agree

Product Subscription Service

Sign up for auto-order and free delivery!

Place a Recurring Delivery Order:

Drop us a line!