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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!

Fields marked with an asterisk (*) are required.

First Name*:

Last Name*:

Email:

Phone:

Pet's Name*

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

5331 S. 204th Avenue, Suite 3
Elkhorn, NE 68022
(402) 322-2842

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Monday: 8:00am - 5:00pm
Tuesday: 8:00am - 5:00pm
Wednesday: 8:00am - 5:00pm
Thursday: 8:00am - 12:00pm
Friday: 8:00am - 5:00pm
Saturday: Closed
Sunday: Closed

Closed daily from 12:30-1:30pm;
Wednesdays from 12:30-2:30pm