- Complete this entire
form. This is the Patient (Pet) Information form, Customer Authorization, and Credit Authorization form.
Note: You may also click on "Click
to Download Form" below if you would like to access
a .pdf version of this form. If you do not have
Adobe Acrobat Reader, please click on the button below for a
free download.

- Please fax or mail your completed form along with a copy of your ORIGINAL PET PRESCRIPTION(s) to:
CanUSAMeds.com
3108 S. Rt. 59
Suite 124-287
Naperville, IL. 60564
-or-
Fax to: 1-866-469-7171
WHAT'S NEXT?
- Each prescription is reviewed by our medical staff and a licensed and professionally registered veterinarian.
- Prescriptions are filled by a licensed Canadian pharmacy and shipped to your home.
Charges:
Drug prices are all inclusive and include veterinarian fee and pharmacy dispensing fee. Shipping
$9.99 U.S. funds Expresspost.
If your order is cancelled after the office consultation and before the order goes to the pharmacy there will be a $20 US administration fee.
After an order has been sent to the pharmacy there is no cancellation. All sales are final.
Please feel free to call us Toll Free 1-877-469-9619 if you have any questions.
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