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Customer Declaration

POM-VPS medicines

A POM-VPS medicine may be prescribed by any RQP. A clinical assessment of the animal(s) does not have to be carried out when prescribing POM-VPS medicines and the animal doesn’t have to be under the RQP’s care. However, the RQP must have sufficient information about the animal and the condition to be treated to enable them to prescribe and supply the most appropriate product.

A customer may request a written prescription if they want to buy the product from a supplier other than the prescribing RQP. RQPs may supply POM-VPS medicines against a written prescription from another RQP.

To enable us to provide the most appropriate POM-VPS product or supply the most appropriate NFA-VPS product, and give advice on safe administration, warnings and contraindications, it is necessary for you to complete this form.

Your items will not be dispatched until the necessary paperwork has been submitted and verified by the appropriately qualified person. Your order may be cancelled and a full refund made if the necessary requirements are not met.

General Information

Food Producing Animals

Individual Horse

Stables or Livery Yards


Any other notes

WE MAY CONTACT YOU IF WE REQUIRE CLARIFICATION OF ANYTHING IN THIS FORM