Outside Internet Pharmacy Waiver

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Outside Internet Pharmacy Waiver Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 734-475-8696 for a faster response.

I hereby request a prescription for purchase from an outside online pharmacy or catalog vendor not associated with Lane Animal Hospital. I have been informed that the following risks exist when I obtain these products from such sources: 

  1. There is no way for my veterinarian to know if the product has been stored properly while in transit, is out of date, repackaged or counterfeit, and may not have been approved by the FDA; the vaccines may not have been approved by the USDA, and the pesticides may not have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. (Many of these sites are operating illegally, from foreign countries where medications are shipped here with no governmental monitoring).  
  2. 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. 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 your pet’s prescribing doctor.
  3. Purchases from outside online pharmacies may not appear in my pet’s medical records provided by my veterinarian. This information may be important in the event that my pet needs additional medications and/or treatment from my veterinarian. 
  4. The manufacturer’s warranties and 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. They will not warrant safety, purity, or efficacy when marketed through these sources. Additionally, the owners of and doctors at Lane Animal Hospital will be unable to assist you in claims against those manufacturers. Lane Animal Hospital cannot take responsibility for the safety of drugs purchased through an online pharmacy.
  5. Manufacturer rebates that would ordinarily be available for products purchased from this facility will not be honored when purchased from online pharmacies or catalog vendors. 
  6. Vaccines that are shipped through surface carriers and that arrive at your home unrefrigerated may be ineffective. Even if you reconstitute the vaccines you receive, you may be unable to administer them properly or may injure yourself or your pet when doing so.
  7. Vaccines purchased through online pharmacies or catalog vendors may not be accepted as valid by kennels, airlines, licensing agencies, or veterinary practices due to the fact that the vaccines were not administered by a veterinarian. 

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 Lane Animal Hospital and its associated staff will be held harmless from the use of products and/or prescriptions purchased from sources outside of the hospital’s monitoring and control. 

I am also aware that Lane Animal Hospital, as of April 1st, 2019, will no longer be approving any fax, email, or phone prescription requests from these types of pharmacies.

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