Lehigh Valley Veterinary Dermatology

4580 Crackersport Rd
Allentown, PA 18104

(610)391-1200

lehighvetderm.com

Allergy Vaccine Refill Form

Name
First Name
Last Name
Pet Name

Phone
Phone TypePhone Number
Shipping Options
Do you want to pick up your vaccine or have it shipped
Pick up at Lehigh Valley Vet Derm
Ship vaccine


Please include detailed shipping address if you would like the vaccine shipped

Are you able to sign for the package? You must be home for delivery!!
yes
no


If unable to sign for the package, do you accept responsibility for lost, misplaced damaged items
I accept full responsibility
No (the item cannot be shipped)


Once the form is completed, follow link above for "Allergy vaccine payment" or call the office

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