SVPMeds Customer Portal
  
  Pet Owner Registration
Owner Information
Email: 
(This will be your Username)
Password: 
Confirm Password: 
Do you have an existing account?  Yes    No
Existing Account #: 
Confirm Account #: 
First Name: 
Last Name: 
Phone: 
Address: 
City: 
State: 
Zip: 
Pet Information
Pet Name: 
DOB / Estimated DOB: 
Pet Weight: 
Species: 
Sex: 
Veterinarian Information (Required for prescription medications)
Doctor's First Name: 
Doctor's Last Name: 
Clinic Name: 
(Optional)
Phone: 
Fax: 
(Optional)
  (For faster authorization please provide your doctor's fax number)
Email: 
(Optional)
Address: 
(Optional)
City:  State:  Zip: 
SVPMeds Customer Portal
  
  Pet Owner Registration
Owner Information
Email: 
(This will be your Username)
Password: 
Confirm Password: 
Do you have an existing account?  Yes    No
Existing Account #: 
Confirm Account #: 
First Name: 
Last Name: 
Phone: 
Address: 
City: 
State: 
Zip: 
Pet Information
Pet Name: 
Estimated DOB: 
Pet Weight: 
Species: 
Sex: 
Veterinarian Information
(Required for prescription medications)
Doctor's First Name: 
Doctor's Last Name: 
Clinic Name: 
(Optional)
Phone: 
Fax: 
(Optional)
  (For faster authorization please provide your doctor's fax number)
Email: 
(Optional)
Address: 
(Optional)
City:  State:  Zip: