Thank you for choosing

This form offers products sold in-clinic ONLY. If you are seeking products NOT offered in-clinic, please visit our Covetrus pharmacy at https://rx.dickinsonmcneill.com.

Note: PRESCRIPTION products require medical history approval and will not be provided if patients do not meet minimum requirements for prescription meds. If your pet is NOT a direct patient of Dr. McNeill, a valid prescription will be required and can be electronically attached to this form.

Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

We will confirm the products you order are appropriate for your pet.

{ binding firstError.message }

 

{ binding firstError.message }

A VALID EMAIL IS REQUIRED. ORDER UPDATES AND PROBLEMS WILL BE REPORTED BY EMAIL FIRST.

Quick Question {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

This survey helps us understand the needs of our customers.

YesNo
{{ $context.parentContext.dataItem.get_label() }}
{ binding firstError.message }
{ binding firstError.message }

HOW TO ORDER

Select a product using dropdown/checkboxes

Select the quantity

HEARTWORM PREVENTATIVES

{ binding firstError.message }

PRESCRIPTION PRODUCT

{ binding firstError.message }

{ binding firstError.message }

PRESCRIPTION PRODUCT

{ binding firstError.message }

{ binding firstError.message }

PRESCRIPTION PRODUCT

{ binding firstError.message }

FLEA + TICK PRODUCTS

{ binding firstError.message }

PRESCRIPTION PRODUCT

{ binding firstError.message }

{ binding firstError.message }

PRESCRIPTION PRODUCT

{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

O'TOM TICK TWISTER TICK REMOVAL TOOL (2-PK) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

**COLORS VARY AND WILL BE SELECTED RANDOMLY.

{ binding firstError.message }

FLEA COMB {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

SUPPLEMENTS

{ binding firstError.message }
{ binding firstError.message }

COMFORT CALM natural anti-anxiety supplement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

GLYCOFLEX JOINT SUPPORT LEVEL 1 perna/glucosamine {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

GLYCOFLEX JOINT SUPPORT LEVEL 2 perna/glucosamine/msm/dmg {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

URINARY CONTROL

{ binding firstError.message }

PRESCRIPTION PRODUCT

{ binding firstError.message }

DENTAL PRODUCTS

{ binding firstError.message }
{ binding firstError.message }

TOYS

{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

PLANET DOG ECO BONE - USA MADE FROM RECYCLED PLASTICS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

HARD CHEWS

{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

{ binding firstError.message }
{ binding firstError.message }

SAFETY PRODUCTS

EZDOG PET SEATBELTS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

** THE CLICK-IN RESTRAINT DOES NOT WORK ON VOLVO VEHICLES

{ binding firstError.message }

CHECKOUT

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Orders paid by check will be shipped once check is received and cleared. We are sorry, but cash cannot be accepted for online orders.

{ binding firstError.message }

Data is secure and transaction will not be processed until order is confirmed.

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Pickup or Ship {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Pickup orders, once completed, will be placed in our pickup box located at the entrance to our clinic. Shipped orders will be sent via USPS First Class mail or Priority Mail, based on your preference.

 

Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Shipping Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Shipping rates are based upon package weight and will be automatically added to your total.

Please note that orders exceeding 15.99 lbs. will require Priority postage by default. Additionally, First Class packages carry no insurance, and if 'lost' or damaged during shipping, we will not be held responsible. If you prefer the benefit of insurance, choose 'Priority Mail'.  This charge is not refundable even if products are returned.

{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }

Required for prescription orders for patients that are NOT patients of Dr. McNeill.

Thank you for choosing

Thank you for choosing

This form offers products sold in-clinic ONLY. If you are seeking products NOT offered in-clinic, please visit our Covetrus pharmacy at https://rx.dickinsonmcneill.com.

Note: PRESCRIPTION products require medical history approval and will not be provided if patients do not meet minimum requirements for prescription meds. If your pet is NOT a direct patient of Dr. McNeill, a valid prescription will be required and can be electronically attached to this form.

Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Pet's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quick Question {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ $dataItem.get_label() }}
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

HOW TO ORDER

Select a product using dropdown/checkboxes

Select the quantity

HEARTWORM PREVENTATIVES

HEARTGARD PLUS chewable beef block for dogs (given monthly) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

TRI-HEART PLUS chewable tablets for dogs (given monthly) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

INTERCEPTOR PLUS chewable tablets for dogs (given monthly) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

FLEA + TICK PRODUCTS

NEXGARD chewable tablets for dogs (given monthly) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

BRAVECTO chewable tablets for dogs (given every 12 weeks) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

K9 ADVANTIX II topical for dogs (applied monthly) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

O'TOM TICK TWISTER TICK REMOVAL TOOL (2-PK) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

FLEA COMB {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

SUPPLEMENTS

OMEGA DHA Capsules - 60 count {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

COMFORT CALM natural anti-anxiety supplement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

GLYCOFLEX JOINT SUPPORT LEVEL 1 perna/glucosamine {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

GLYCOFLEX JOINT SUPPORT LEVEL 2 perna/glucosamine/msm/dmg {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

URINARY CONTROL

PROIN (regular and extended release) bladder tightener  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

DENTAL PRODUCTS

ORAL CLEANSING WIPES (100 ct.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

TOYS

PLANET DOG 3" SQUEAK BALLS- USA MADE, 5/5 DURABILITY RATING {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

PLANET DOG 3" BIRTHDAY BALL- USA MADE, 5/5 DURABILITY RATING {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

PLANET DOG 2.5" BALLS- USA MADE, 5/5 DURABILITY RATING {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

PLANET DOG SPORT TOYS- USA MADE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

PLANET DOG ECO BONE - USA MADE FROM RECYCLED PLASTICS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

PLANET DOG TOYS - FOR SMALL DOGS - USA MADE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

KONG PUPPY 4" CHEW FOR DOGS 30-65 LBS. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

HARD CHEWS

REDBARN NATURALS WHITE SHIN BONES {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

ANTLERZ ALL NATURAL DEER ANTLER  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

HIMALAYAN DOG CHEWS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

SAFETY PRODUCTS

EZDOG PET SEATBELTS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

CHECKOUT

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Credit/Debit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Expiration Date  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Security Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Name on Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Pickup or Ship {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Shipping Options {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Prescription Upload {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Cognito Forms{{ Cognito.resources["powered-by-cognito"] }}