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Waiver for Internet Pharmacies and Vendors
College Road / Carolina Beach Animal Hospital

WAIVER OF RESPONSIBILITY AND LIABILITY FOR PRESCRIPTIONS TO BE FILLED BY INTERNET PHARMACIES OR CATALOG VENDORS

I hereby request a prescription for medication so that I can purchase these products from an internet pharmacy or catalog vendor. I have been informed that the following risks exist when I obtain these products from such sources.

1. There is the possibility that the prescription drugs received from these vendors may be counterfeit and may not have been approved by the FDA, and pesticides may not have been approved by the EPA. This has occurred in the past and could recur.

2. As the provider of your pets 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 to send reminders for follow-up exams and /or lab tests that may be needed to monitor results, adverse reactions or potentially harmful drug interactions.

3. You may not have the prescription drugs available soon enough to start your pet’s medications at the optimal time to provide relief for his or her condition.

4. The number of tablets or capsules, milligram size of the unit, volume and/or concentration of liquid, and number of authorized refills may differ from that prescribed by the attending doctor.

5. Manufacturer rebates that would ordinarily be available for products purchased from this hospital are not available.

6. Manufacturer’s warranties or guarantees for these products are not valid with internet or catalog prescriptions. This means that if your pet’s condition is not effectively treated with the product, manufacturers will not stand behind their products or product liability procedures.

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 purchased from any other source.