POM-VPS Form (Horses)

The product you are ordering is a Prescription Only Medicine this includes Horse Wormers
To enable us to prescribe this for you please could you complete the questionnaire below.
Unfortunately we are unable to process your order without the completion of this form.
If you are experiencing any difficulties please contact us on 01425 474455

Your Email

Your Name

Product Required

Are you the registered keeper/owner of the horse(s) to be treated?

Yes

If you replied 'No' to the above, please supply the name and address of the registered keeper

Please confirm your horse been signed out of the food chain in the passport?

Section nine IX of a horse passport allows the owner to declare whether the horse is intended for the food chain or not. Horses opted out of the food chain can be prescribed all licenced veterinary medicines authorised for both food and non-food producing horses, including all wormers. If you answer "NO" please phone us on 01425 474455 to discuss your worming options

Yes

If we are unable to view your horses passport, please note the withdrawal periods apply as detailed below

Equest Pramox - Meat and offal: 64 days

Milk: not permitted for use in lactating mares producing milk for human consumption

Equest - Meat and offal: 32 days

Strongid P - Zero Withdraw

Equimax - Meat withdrawal 35 days

Not permitted for use in horses producing milk for human consumption

Eraquell - 30 days meat withdrawal

Do not use in mares producing milk for human consumption

Panacur Equine Guard - Not to be used in horses intended for human consumption

Panacur Paste - Not to be used in horses intended for human consumption

Deosect - Not to be used in animals intended for human consumption

Please the give age of any horses under 12 months

Number of horses to be treated

What is the weight of the horses to be treated?

Have you used this product before?

Yes

What product did you use last time and when?

Why does your horse require treatment?

Select allClear choices

Following Vet Advice

Following FEC, Saliva or Blood Test Results

Part Of Yard/Health Worming Programme

Other:

If you answered "other" above, why is treatment required?

Please provide any further information to help us correctly prescribe your medicine?

Have any of the horses to be treated ever suffered an adverse reaction?

Yes

Please acknowledge you will read the data sheet before administration and are aware of the appropriate safety precautions

Yes

Would you like a phone call from an SQP to discuss safe administration of this product or for any further advice?

If yes, please enter Phone Number below

Yes

Phone Number