New Client Form

I Hereby request a prescription for medication(s) for my pet so that I can purchase these products from an outside internet pharmacy or catalog vendor not associated with this clinic. 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 Legacy 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.

Risks Involved in Purchasing Pharmaceuticals or Other Products for My Pet From Internet Pharmacies or Catalog
Vendors May Include and Are not Limited To:

There is no way for my veterinarian to know if the product has been stored properly when in transit, is out of date, repackaged or counterfeit when purchased from outside internet source. This is a valid concern as it has occurred in the past and is likely to recur at any time. For more information on this topic, visit the FDA website at www.fda.gov and enter Internet Pharmacies in the FDA search bar.

The prescribing instructions for product purchase from other sources may be different from those recommended by my veterinarian. This could result in improper dosing of my pet.

Purchases from outside on-line pharmacies may not appear in my pet’s medical records provide by my veterinarian. This information may be important in the event that my pet needs additional medications and/or treatment from my veterinarian.

Product warranties for prescriptions obtained from outside internet pharmacies may be different than the manufacture’s normal warranties or potentially unavailable. It is understood that my veterinarian is unable to offer warranties for products of prescriptions obtained through outside sources.

The prescription and/or its refills may not arrive in a timely fashion, thus potentially causing an interruption in treatment for my pet, which may result in the need for additional testing prior to the continued safe use of the product.

Manufactured rebates that would ordinarily be available for products purchased from this facility will not be honored when purchased from online pharmacies or catalog vendors.

Vaccines purchased through internet pharmacies or catalog vendors may not be accepted as valid by kennels, airlines, licensing agencies or veterinary practices.