Pharmacy Waiver

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Bernalillo Pet Care Center Pharmacy Waiver

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.

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I hereby request a prescription for medication(s) for my pet 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. *

I have read and understood the above statement.

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 occurred in the past and could recur. *

I have read and understood the above statement.

2) As the provider of your pet’s care, our medical records keep track of all drugs dispensed to us to you. When you purchase your prescriptions elsewhere, our computer tracking system is not activated to print instructions for use or risk of adverse effects or to send reminders for follow-up exam and/or lab tests that may be needed to monitor results or adverse reactions.

I have read and understood the above statement.

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

I have read and understood the above statement.

4) When prescription products are purchased elsewhere, our staff members are unavailable to teach you how to administer them.

I have read and understood the above statement.

5) 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.

I have read and understood the above statement.

6) Manufacturer rebates that would ordinarily be available for products purchased from this facility generally will not be available.

I have read and understood the above statement.

7) The manufacturer’s warranties or 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. Additionally, the owners of and doctors at this facility will be unable to assist you in claims against those manufacturers

I have read and understood the above statement.

I have read and understand the above information. I accept the 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. *

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Pharmacy Waiver

Bernalillo Pet Care Center Pharmacy Waiver

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