test products

Have you already completed this questionnaire for the same animals, for a different animal medicine on this order?

1 Yes or No response

Which product on the order has the relevant information?

Which animal details are to be used for this animal medicine?

Why have you ordered this product and what parasites do you want to treat with it? NOTE if it is following any test results please detail the results and date of the tests here.

When did you last test or treat for these parasites?

Which test or product did you use?

Why do you think you need to treat now?

How many animals are you treating with this order?

How are you setting the dosing weight for this product?

Have you used this product previously?

2. Yes or No response

Has there been any adverse reactions to this product?

Can you confirm that you have read the contra indications for this product and are aware of how to use it safely?

This product will come with a package insert containing all contra indications, safety instructions, dosing requirements and instructions. These are also on our website. Please confirm that you will read these prior to using this product

Which specie of animal are you treating?

Animal species list

Have you ordered a sheep dip product?

Please provide the following details from the Certificate of Competence or Level 2 Award in the Safe Use of Sheep Dips
Name of Certificate of Competency Holder

Please email a copy of the certificate or award if you have not already registered one with a previous order to support@epla.co.uk

Are these animals food producing animals

What is their intended food use?

When are they intended for this use

What is the applicable withdrawal period for the animal medicine ordered?

Are the animals to be treated in general good health with no immediate concerns?

Please detail

How does this animal medicine form part of your animal health plan?

How frequently do you use worm egg counts or elisa tests to assess worm activity?

Do you follow SCOPS or COWS recommendation?

Would you like assistance with your animal health plan or any test results?

Dog / Cat

B. Have you previously completed details for the pet you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.

I have not entered details before or they have changed and I need to update them.

Are you treating one pet?

Name of Pet

Weight

Age

Is it on any other medication?

Please detail medication

Please confirm that your pet is in good health with no health concerns.

Is your pet pregnant or lactating?

Option to add more than one

PET 1 Name of Pet: Weight: Age: Is it on any other medication? YES/NO Please detail medication if YES: Please confirm that your pet is in good health with no health concerns: Is your pet pregnant or lactating?: ---------------------------------------------------------------------------------------------------------------------------------------- PET 2 Name of Pet: Weight: Age: Is it on any other medication? YES/NO Please detail medication if YES: Please confirm that your pet is in good health with no health concerns: Is your pet pregnant or lactating?: ---------------------------------------------------------------------------------------------------------------------------------------- PET 3 Name of Pet: Weight: Age: Is it on any other medication? YES/NO Please detail medication if YES: Please confirm that your pet is in good health with no health concerns: Is your pet pregnant or lactating?:

How frequently do you worm?

When did you last worm?

Narrative box for other

With which product?

How frequently do you treat for fleas and ticks?

When did you last treat for fleas and ticks?

With which product?

Narrative box for other

Do you carry out worm egg counts to check that your worming programme is effective?

Would you like assistance with your annual worming, flea and tick treatment plan?

Thank you for completing the required information for our prescribers to be able to review your order.
Please ensure that if you are dosing multiple animals with the same drenching gun that you set it for the heaviest animal.
Every animal medicine product contains contra warnings and indications, together with dosing instructions. Please ensure that you read these before giving the animal medicine to ensure the optimum health of your animal.
If you require any assistance with your prescription, then please contact our prescription advice line on 01267 223322 between 8am and 6pm. Outside of these hours please email support@epla.co.uk.
Rabbits / Hamsters / Guinea Pigs / Reptiles / Exotics / Other small pets

C. Have you previously Have you previously completed details for the pet you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.

Are you treating one animal?

Name of Animal

Weight

Age

Is it on any other medication?

Please detail medication

Please confirm that your pet is in good health with no heath concerns.

Is your pet pregnant or lactating?

Option to add more than one

Animal 1 Name of Pet: Weight: Age: Is it on any other medication? YES/NO Please detail medication if YES: Please confirm that your pet is in good health with no health concerns: Is your pet pregnant or lactating?: ---------------------------------------------------------------------------------------------------------------------------------------- Animal 2 Name of Pet: Weight: Age: Is it on any other medication? YES/NO Please detail medication if YES: Please confirm that your pet is in good health with no health concerns: Is your pet pregnant or lactating?: ---------------------------------------------------------------------------------------------------------------------------------------- Animal 3 Name of Pet: Weight: Age: Is it on any other medication? YES/NO Please detail medication if YES: Please confirm that your pet is in good health with no health concerns: Is your pet pregnant or lactating?:

How frequently do you worm?

When did you last worm?

With which product?

How frequently do you treat for fleas and/or mites?

When did you last treat for fleas or mites?

With which product?

Do you carry out worm egg counts to check that your worming programme is effective?

Would you like assistance with your annual worming, flea and mite treatment plan?

Thank you for completing the required information for our prescribers to be able to review your order.
Please ensure that if you are dosing multiple animals with the same drenching gun that you set it for the heaviest animal.
Every animal medicine product contains contra warnings and indications, together with dosing instructions. Please ensure that you read these before giving the animal medicine to ensure the optimum health of your animal.
If you require any assistance with your prescription, then please contact our prescription advice line on 01267 223322 between 8am and 6pm. Outside of these hours please email support@epla.co.uk.
Poultry and Birds

D. Have you previously completed details for the animals you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.

I have not entered details before or they have changed and I need to update them.

Thank you for completing the required information for our prescribers to be able to review your order.
Please ensure that if you are dosing multiple animals with the same drenching gun that you set it for the heaviest animal.
Every animal medicine product contains contra warnings and indications, together with dosing instructions. Please ensure that you read these before giving the animal medicine to ensure the optimum health of your animal.
If you require any assistance with your prescription, then please contact our prescription advice line on 01267 223322 between 8am and 6pm. Outside of these hours please email support@epla.co.uk.

Are the animals to be treated in general good health with no immediate concerns?

Please detail

How frequently do you worm?

Other details

When did you last worm?

With which product?

How frequently do you treat for mites?

Other Details

When did you last treat for mites?

With which product?

Do you carry out worm egg counts to check that your worming programme is effective?

Would you like assistance with your annual worming and mite treatment plan or any test results?
Horses and Donkeys

E. Have you previously completed details for the equine you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.

Thank you for completing the required information for our prescribers to be able to review your order.
Please ensure that if you are dosing multiple animals with the same drenching gun that you set it for the heaviest animal.
Every animal medicine product contains contra warnings and indications, together with dosing instructions. Please ensure that you read these before giving the animal medicine to ensure the optimum health of your animal.
If you require any assistance with your prescription, then please contact our prescription advice line on 01267 223322 between 8am and 6pm. Outside of these hours please email support@epla.co.uk.

I have not entered details before or they have changed and I need to update them

Are you treating one animal?

Name of Animal

Weight

Age

Type of Equine

Has the declaration that they are NOT for Human Consumption been completed in their Passport?

Is this equine in general good health with no immediate concerns?

Please detail

Option to add more than one

Animal 1 Name of Animal: Weight: Age: Type of Equine – Dropdown [Mare / Gelding / Stallion / In Foal Mare / Lactating Mare / Donkey / Mule: Has the declaration that they are NOT for Human Consumption been completed in their Passport?: Is this equine in general good health with no immediate concerns? YES / NO / Please detail: --------------------------------------------------------------------------------------------------------------------------------------------------------------------------. Animal 2 Name of Animal: Weight: Age: Type of Equine – Dropdown [Mare / Gelding / Stallion / In Foal Mare / Lactating Mare / Donkey / Mule: Has the declaration that they are NOT for Human Consumption been completed in their Passport?: Is this equine in general good health with no immediate concerns? YES / NO / Please detail: -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Animal 3 Name of Animal: Weight: Age: Type of Equine – Dropdown [Mare / Gelding / Stallion / In Foal Mare / Lactating Mare / Donkey / Mule: Has the declaration that they are NOT for Human Consumption been completed in their Passport?: Is this equine in general good health with no immediate concerns? YES / NO / Please detail: --------------------------------------------------------------------------------------------------------------------------------------------------------------------------

How frequently do you worm/test for tapeworm?

Other Details

When did you last worm?

With which product?

How frequently do you worm/test for small redworm?

Other Details (Redworm)

Do you carry out worm egg counts to check that your worming programme is effective?

What is their risk assessment grading?

Would you like assistance with your risk assessment and annual worming and testing plan, or any test results?

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test products

Have you already completed this questionnaire for the same animals, for a different animal medicine on this order?

1 Yes or No response

Which product on the order has the relevant information?

Which animal details are to be used for this animal medicine?

Why have you ordered this product and what parasites do you want to treat with it? NOTE if it is following any test results please detail the results and date of the tests here.

When did you last test or treat for these parasites?

Which test or product did you use?

Why do you think you need to treat now?

How many animals are you treating with this order?

How are you setting the dosing weight for this product?

Have you used this product previously?

2. Yes or No response

Has there been any adverse reactions to this product?

Can you confirm that you have read the contra indications for this product and are aware of how to use it safely?

This product will come with a package insert containing all contra indications, safety instructions, dosing requirements and instructions. These are also on our website. Please confirm that you will read these prior to using this product

Which specie of animal are you treating?

Animal species list

Have you ordered a sheep dip product?

Please provide the following details from the Certificate of Competence or Level 2 Award in the Safe Use of Sheep Dips

Please email a copy of the certificate or award if you have not already registered one with a previous order to support@epla.co.uk

Are these animals food producing animals

What is their intended food use?

When are they intended for this use

What is the applicable withdrawal period for the animal medicine ordered?

Are the animals to be treated in general good health with no immediate concerns?

Please detail

How does this animal medicine form part of your animal health plan?

How frequently do you use worm egg counts or elisa tests to assess worm activity?

Do you follow SCOPS or COWS recommendation?

Would you like assistance with your animal health plan or any test results?

Dog / Cat

B. Have you previously completed details for the pet you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.

I have not entered details before or they have changed and I need to update them.

Are you treating one pet?

Name of Pet

Weight

Age

Is it on any other medication?

Please detail medication

Please confirm that your pet is in good health with no health concerns.

Is your pet pregnant or lactating?

Option to add more than one

How frequently do you worm?

When did you last worm?

Narrative box for other

With which product?

How frequently do you treat for fleas and ticks?

When did you last treat for fleas and ticks?

With which product?

Narrative box for other

Do you carry out worm egg counts to check that your worming programme is effective?

Would you like assistance with your annual worming, flea and tick treatment plan?

Thank you for completing the required information for our prescribers to be able to review your order.

Rabbits / Hamsters / Guinea Pigs / Reptiles / Exotics / Other small pets

C. Have you previously Have you previously completed details for the pet you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.

Are you treating one animal?

Name of Animal

Weight

Age

Is it on any other medication?

Please detail medication

Please confirm that your pet is in good health with no heath concerns.

Is your pet pregnant or lactating?

Option to add more than one

How frequently do you worm?

When did you last worm?

With which product?

How frequently do you treat for fleas and/or mites?

When did you last treat for fleas or mites?

With which product?

Do you carry out worm egg counts to check that your worming programme is effective?

Would you like assistance with your annual worming, flea and mite treatment plan?

Thank you for completing the required information for our prescribers to be able to review your order.

Poultry and Birds

D. Have you previously completed details for the animals you are ordering for AND those details remain unchanged?

Please enter the previous order number below that contains the relevant prescription information.