EmailMe Form - Place an Order

Your Name *

First Last

Your Email *

Horse Name (Registered) *

If the horse does not have a Registered Name, please enter Barn Name.

Horse Name (Barn)

Please include any Aliases that might expedite our location of appropriate records.

Have We Seen This Horse Previously? *

YES

NO

Unknown

Are You a REGULAR CLIENT of The ATLANTA EQUINE CLINIC?* *

YES, I am a Regular Client of The ATLANTA EQUINE CLINIC.

NO, I am not a Regular Client of The ATLANTA EQUINE CLINIC, but I am not ordering Prescription Medication(s).

NO, I am not a Regular Client of The ATLANTA EQUINE CLINIC, but a PRESCRIPTION from my Primary Veterinarian is attached to this ORDER.

*Prescription Medications may only be dispensed to REGULAR CLIENTS of The ATLANTA EQUINE CLINIC.

The following must be completed for Non-Regular Clients of The ATLANTA EQUINE CLINIC:

Your Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Your Phone Number

### - ### - ####

Please allow up to 10 days to process your order.

Items Ordered* *

*Include Size and Quantity next to Item separated by commas (e.g. Bute Paste, 12g tube, 1)

Comments, Questions and/or Special Requests

Attach Prescription*

*A Prescription must be provided by your PRIMARY VETERINARIAN if you are not a Regular Client of The ATLANTA EQUINE CLINIC.