Remote Reassessment for Repeat Prescriptions

For the majority of our patients, ongoing medications can be provided by their regular veterinarian either directly or via a prescription to their local pharmacy. Unless we’ve instructed you otherwise, please talk to your regular veterinarian first. Then if there’s any questions please get in touch via email or phone.

We can provide Tacrolimus repeats to our dry eye patients if their referring clinic would prefer for us to prescribe this medication.

To continue providing this medication we need to perform 6-monthly reassessments. This can be done in-person, or via remote consultation with your regular veterinarian. If you are having reassessments done remotely you will need to book an appointment with your usual veterinarian. They will examine your pet and submit their examination findings on the form below. We will then evaluate the findings and advise on whether any chances are needed to the medication plan. We can then continue to courier medications to you until your next reassessment is due.

Tacrolimus Repeats

Referring veterinarian to complete

Pet's name *

Client's name *

Veterinarian's name *

Veterinarian's email address *

Client's address (for shipping medications) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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What medications is the pet currently on?

Medication *

Frequency *

Time last given *

Medication

Frequency

Time last given

Medication

Frequency

Time last given

Medication

Frequency

Time last given

How well does the owner feel the problem is controlled? *

How does the eye appear to you? (discharge, conjunctival redness, corneal neovascularisation, corneal pigmentation) *

Menace response

In the left eye the menace response is *

• Present
• Absent

In the right eye the menace response is *

• Present
• Absent

Pupiliary light reflexes

In the left eye the direct PLR is *

• Present
• Absent
• Slow/incomplete

In the right eye the direct PLR is *

• Present
• Absent
• Slow/incomplete

In the left eye the indirect PLR is *

• Present
• Absent
• Slow/incomplete

In the right eye the indirect PLR is *

• Present
• Absent
• Slow/incomplete

Dazzle reflex

In the left eye the dazzle reflex is *

• Present
• Absent

In the right eye the dazzle reflex is *

• Present
• Absent

Schirmer Tear Test

In the left eye the schirmer tear test is *

In the right eye the schirmer tear test is *

Do you or the client have any other questions or comments?

Does the client need medications couriered immediately on completion of this remote reassessment? *

• Yes
• No

Is your clinic happy to provide emergency care for this patient should they have any adverse reaction to treatment? *

• Yes
• No

For Pet Eye Care to prescribe medications to remote clients, they must have local emergency care available if an issue arises with the prescribed medication (as per the ACVM act 1997)

Is your clinic is part of Vet Partners group? *

• Yes
• No

For invoicing purposes

I understand my clinic will be charged $70 for this remote reassessment *

• Yes
• No

If anything changes with this patient's condition in the next 6 months which may impact the treatment of the patient's eye condition please ensure the client is fully informed and Pet Eye Care is kept updated

Submit