External Online Pharmacy Waiver

WAIVER OF RESPONSIBILITY AND LIABILITY FOR PRESCRIPTIONS FILLED BY EXTERNAL* INTERNET or CATALOG PHARMACIES I hereby request a prescription or an electronic authorization for a medication, supplement food or preventative from an external internet or catalog pharmacy that is not affiliated with Tuscawilla Oaks Animal Hospital. I have been informed that the following risks exist when I obtain these products from external, non-regulated sources.
1. There is the possibility that the prescription drugs or products received from the external* online or catalog pharmacy may be counterfeit, out of date, improperly stored or incorrectly formulated and may not have been approved by the FDA or EPA.
2. Any manufacturer guarantee is not valid when drugs or products or are purchased from external* online or catalog pharmacies and if your pet’s condition is not effectively treated, then the manufacturers will not stand behind their drugs or products or their liability procedures, including reimbursements.
3. Any manufacturer rebate that would ordinarily be available for products, food or drugs that are purchased directly from our hospital or our regulated online pharmacy** will not be available.
4. Pet Parent’s data is safe with our regulated online pharmacy** as it is a legitimate pharmacy. External* online or catalog pharmacies may share your information to third parties.
5. As the provider of your pets’ care, our medical records keep track of all drugs and products dispensed by us. When you purchase your drugs or product elsewhere, our computer tracking system is not activated to send reminders.
I have read and understand the above, accept these risks, and am aware that Tuscawilla Oaks Animal hospital cannot accept any financial responsibility for paying for or reimbursing me for any treatments required as a result of the use of products purchased on an external* online or catalog pharmacies. I agree to hold this veterinary practice harmless for any side effects or lack of effectiveness of drugs or products purchased from external* online or catalog pharmacies.*
I have read and understand the above.
Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
*External refers to NON veterinary regulated online or catalog pharmacies. ** TOAH’s regulated and authorized online pharmacies and stores are VetSource, Purina Vet Direct and Hill’s to Home.

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External Online Pharmacy Waiver