Free Veterinary Prescription Template
Veterinary Prescription
[YOUR COMPANY NAME]
Date: October 8, 2055
I. Veterinarian Information
Veterinarian Name: [YOUR NAME], DVM
License Number: 987654321
Email: [YOUR EMAIL]
II. Client and Patient Information
|
Field |
Details |
|---|---|
|
Owner's Name: |
Maryjane Dare |
|
Owner's Address: |
Irvine, CA 92602 |
|
Phone: |
222 555 7777 |
|
Patient Name (Animal): |
Max |
|
Species: |
Canine |
|
Breed: |
Labrador Retriever |
|
Age: |
5 years |
|
Weight: |
65 lbs |
|
Microchip ID: |
1234567890 |
III. Prescription Details
|
Medication |
Dose |
Frequency |
Duration |
Instructions |
|---|---|---|---|---|
|
Amoxicillin |
250 mg |
Twice daily |
7 days |
Administer orally with food |
|
Prednisone |
5 mg |
Once daily |
5 days |
Administer with food, reduce dosage gradually |
|
Tramadol |
50 mg |
As needed (up to 3x/day) |
10 days |
Administer for pain management |
IV. Special Instructions
-
Ensure the animal is hydrated and well-fed during the treatment.
-
Monitor for any signs of allergic reactions such as swelling, difficulty breathing, or hives.
-
If symptoms worsen, contact the clinic immediately.
-
Do not discontinue medication without consulting a veterinarian.
V. Refills
|
Medication |
Refills |
|---|---|
|
Amoxicillin |
0 |
|
Prednisone |
1 |
|
Tramadol |
1 |
VI. Signature and Authorization
I, [YOUR NAME], hereby prescribe the medications listed above for the patient under my care, and confirm that they are necessary for the treatment of the listed condition.
Date: October 8, 2055
This prescription is valid for veterinary use only and is intended solely for the animal named above.
