Online Pharmacy Waiver Form

Waiver Of Responsibility And Liability For Prescriptions to be filled by outside internet pharmacies not associated with this clinic.

APPOINTMENT

Online Pharmacy Waiver Form

Why Carolinas Veterinary Care Clinic pharmacy is the best choice for your pet.

PRICE: Internet Pharmacies are not always the cheapest source for medication. Our price for most items is typically less than most Internet Pharmacies would charge. In addition, some medications are temperature sensitive and require next day or 2nd day air delivery, which adds to the cost.

REBATES: Our veterinary practice also passes on manufacturers’ promotions and/ or rebates and these frequently result in greater savings. These rebates are not usually

available from online stores or catalogs.

GUARANTEE: Pharmaceutical manufacturers will only honor product guarantees when the medications are prescribed by and purchased from the pet’s veterinarian. Internet and mail-order catalogs, do not qualify for these guarantees.

SAFETY: Any prescription medication purchased from our hospital has been

inspected and approved by the FDA, and manufactured and packaged according to

U.S. government regulations. Medications purchased online may have been purchased

outside the United States and may have different strengths and labeling than U.S. products. Sometimes you can tell by checking the label. If approved by the FDA, it should say, “Caution: Federal law restricts this drug to be used by or on the order of a licensed veterinarian”. Do not use products that do not have this warning or if the label has been removed.

If you would still like to purchase your medication online please read and sign the following:

Please note any fields with * are required.

Name *

First

Last

Phone *

Email *

Pet's Name *

I hereby request a prescription for medications(s) for my pet so that I can purchase these products from an outside internet pharmacy not associated with this clinic. By signing this waiver, I acknowledge that I have been properly informed of the risks involved in doing so, and accept any and all responsibility, financial or otherwise, that may occur from this decision. I understand that this clinic will be held harmless from the use of products and/or prescriptions purchased from sources outside of the clinic’s monitoring and control. Please Check the box that you understand the following:

There is no way for my veterinarian to know if the product has been stored properly while in transit, is out of date, repackaged or counterfeit when purchased from outside internet source. This has occurred in the past. For more information on this, visit the FDA website at www.fda.gov. *

I understand

The prescribing instructions for products purchased from other sources may be different from those recommended by my veterinarian. This could result in improper dosing of my pet. *

I understand

Purchases from outside on-line pharmacies may not appear in my pet’s medical records provide by my veterinarian. This information may be important in the event that my pet needs additional medications and/or treatment from my veterinarian. *

I understand

Product warranties for prescriptions obtained from outside internet pharmacies may be different than the manufacturer’s normal warranties or potentially unavailable. It is understood that my veterinarian is unable to offer warranties for products of prescriptions obtained through outside sources. *

I understand

The prescription and/or its refills may not arrive in a timely fashion, thus potentially causing an interruption in treatment for my pet, which may result in the need for additional testing prior to the continued safe use of the product. *

I understand

I have read and understood the above risks in using an outside internet pharmacy that is not associated with this veterinary clinic. *

I understand

Signature *

Clear Signature

Date *

Online Pharmacy Waiver Form

Online Pharmacy Waiver Form

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