Form #
Date
03
/
04
/
2025
Request for Compounded Veterinary Medicine
Physical Form Upload
Do you have a completed form ready for upload?
If you have a physical form upload it now or continue to fill out a new form.
Yes
No
Upload prescription or completed order form if you have one.
Or email it directly to us at
vets@compoundlabs.co.nz
Delete all uploads
Choose files or drag here
Requesting Practice's Information
Practice Name
Contact Name
Phone Number
(+64)
Email
Practice Address
Request Medication
Add Medication:
If you would like a quote please email your request to
vets@compoundlabs.co.nz
Medication Name and Strength
Name
Strength
Quantity to be dispensed on each occasion
Directions
Dose (mg) and frequency
Period of Treatment
Period of Treatment
Additional Directions (if any)
Animal/Owner Details
Owner's Full Name
Animal Name
Animal Species
Veterinarian Details
Veterinarian Name
Veterinary Registration #
Veterinary Registration #
Veterinary Signature
Clear
+ Add another medication
Please note that an incomplete order form or prescription may result in delays with processing the order.
Conditions of Supply
I agree to the conditions [HERE]
Submit Form
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