Veterinary Registration Form

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CareFirst Veterinary Pharmacy
2200 Garry Road Suite 1
Cinnaminson, NJ 08077
Office: 856-267-0528 / Toll Free: 844-822-7379
Fax: 856-267-0529 / Toll Free: 844-922-7379
E-mail:
Veterinary Registration Form
Legal Name of Business:
Name of Clinic:
Owner’s Name:
Mailing Address:
Street
City
State
Zip
Shipping Address:
(if different)
Street
City
State
Zip
Phone:
Fax:
Email:
Your Care Team
Veterinarian's Name
License Number
DEA Number
Email
Veterinarian's Name
License Number
DEA Number
Email
Veterinarian's Name
License Number
DEA Number
Email
Veterinarian's Name
License Number
DEA Number
Email
Office Contact/Office Manager:
Email:
How did you hear about CareFirst Veterinary Pharmacy?
Referral
Website
Mailer
Sales Team
Other
Compounded products you are interested in:
At CareFirst, we value our relationship with veterinarians and would like to know if you have any additional non-sterile products that
you would like us to compound for your prescribing needs:
Other Comments:
Shipping Terms: Please call us or visit our website for up to date shipping information and promotions. Orders placed after 4pm EST will be processed the next
business day. Compounded medications may require additional processing time.
Returns: At CareFirst we value your business and do what we can to keep our patients and veterinarians satisfied. We will return products received in error or
damaged in shipping. Please notify us within 10 days of receiving the shipment. All medications returned to CareFirst Specialty pharmacy must be authorized prior to
returned shipment. All unauthorized returns will be discarded and the product will not be credited. Under certain circumstances we will not be able to accept returns
due to rules and regulations including but not limited to: Control substances, Hazardous materials, sold on a non-returnable basis, expired product, products
damaged, soiled or adulterated, refrigerated or frozen products.
Thank you for choosing CareFirst Veterinary Pharmacy
Please Fax completed form to (844)922-7379 or e-mail to

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