Prescription Waiver Form

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Waiver of Responsibility and Liability for Prescriptions to be Filled by Internet Pharmacies or Catalog Vendors

I hereby request a prescription for the medication(s) or vaccination(s) for my pet so that I can purchase these products from an internet pharmacy or catalog vendor. I have been informed of the following risks when obtaining these products from such sources:
  1. There is a possibility that the prescription drugs received from these vendors may be counterfeit and may not have been approved by the FDA; the vaccines may not have been approved by the USDA; and the pesticides may not have been approved by the EPA. This has occurred in the past and could recur.
  2. As the provider of your pet’s care, our medical records keep track of all drugs dispensed by us to you. When you purchase your prescriptions elsewhere, our computer tracking system is not activated to print instructions for use or risks of adverse effects, or to send reminders for follow-up exams and/or lab tests that may be used to monitor the results of adverse reactions.
  3. You may not have the prescription drug(s) available soon enough to start your pet’s medications at the optimal time to provide relief for his/her condition.
  4. When prescription products are purchased elsewhere, our staff members are unavailable to teach you how to administer them.
  5. The number of tablets or capsules, milligram size of the unit, volume and/or concentration of the liquid, and number of authorized refills may differ from that prescribed by the attending doctor.
  6. Manufacturer rebates that would ordinarily be available for products purchased from this facility generally will not be available.
  7. The manufacturer’s warranties or guarantees for these products may not be valid. This means if your pet’s condition is not effectively treated with the product(s), manufacturers may not stand behind their products or product liability procedures. Additionally, the owners and the doctors of this facility will be unable to assist you in claims against the manufacturers.
  8. Vaccines that are shipped through surface carriers and arrive at your home unrefrigerated may be ineffective. Even if you reconstitute the vaccine you receive, you may be unable to administer it properly or may injure yourself or your pet when doing so.
  9. Due to the fact the vaccines were not administered by a veterinarian, they may not be accepted as valid by kennels, airlines, licensing agencies, or veterinary practices.


I have read and understand the above, accept these risks, and am aware that this facility cannot accept any financial responsibility for paying for or reimbursing me for any treatments required as a result of the use of products purchased from these sources. In the absence of negligence, I agree to hold this veterinary practice harmless for any deleterious effects or lack of effectiveness of drugs or vaccines purchased from any other source.

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