Owner Information Form
Prescription Refill Request
Online Pharmacy Waiver
In keeping with our efforts to provide your pets with the best care available, we want our clients to be able to make an informed decision regarding the use of internet pharmacies. Our Online Pharmacy Waiver details some important risks to keep in mind when making this choice.
If you still choose to use an online pharmacy, the waiver needs to be signed and will become a part of your pet’s medical record. After requests are approved by a veterinarian, a written prescription will then be made available for pick-up. LPAH will not mail or fax prescriptions.
For additional information about internet pharmacies, please visit the AVMA website by clicking here.
I hereby request a prescription for purchase 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. Internet sites that sell pet drugs can be reputable pharmacies. However, others are
fronts for businesses breaking federal, state, and sometimes, international laws. Illegal online pharmacies may sell medicines that are counterfeit, outdated, mislabeled, incorrectly formulated, or improperly made or stored. These medicines may not contain the actual drug, may contain contaminants or the incorrect amount of drug, may not work as well due to age or being stored in conditions that were too hot, cold, or humid, and may not have the proper directions for use.
2. As the provider of your pet’s care, our medical records keep track of all drugs dispensed by us to you. When prescriptions are purchased elsewhere, we are unable to print instructions for use or to send reminders for follow-up exams or lab tests that may be needed to monitor results or adverse reactions.
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. Also, manufacturer 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 Longs Peak 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 from internet pharmacies. 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.