Medical Questionnaire

In order to purchase this licensed medicine, you are required to complete the form below for the animal(s) you plan to treat. We are unable to dispatch your order until we have this information; it is a legal requirement by the Veterinary Medicines Directorate (VMD) who regulate veterinary medicines in the United Kingdom.

Our Registered Animal Medicines Advisor (RAMA) must determine if this medicine is appropriate, safe and suitable for your pet prior to its' supply.

Please contact our RAMA if you have any queries - please email, call or use our website contact form and we will be happy to help you and your pet.

If you plan to checkout with this item shortly, we suggest completing this form now to prevent any dispatch delay. Should any details require clarification, we will contact you prior to dispatch.

Pet Name(s) & Species *

Age, sex & weight: *

Condition you wish to treat *

Current Health or Pregnant/Nursing? *

Other medication *

Your Full Name *

Address of Pets (if different to your delivery address)

Email Address *

Your Phone

I confirm I will read the supplied Summary of Product Characteristics information sheet (SPC), detailing properties, use, warnings and product safety prior to the use of this medicine *

I confirm I have used this before, or will request advice from The Hay Experts or my local vet prior to use, if I have any question on product application or suitability *

Thank you for completing this medical questionnaire.

Thank you for taking the time to provide this information; we will contact you if we have any queries.

You may now close this box and complete checkout.

Thank you for completing this medical questionnaire.

Thank you for taking the time to provide this information; we will contact you if we have any queries.

You may now close this box and complete checkout.

Leucillin