Online Pharmacy Prescription Waiver

This form is required the first time you have requested a prescription medication or food to be filled from a NON-veterinary associated or brick-and-mortar pharmacy. Due to the risks of filling medications or food from these sources, please fill out the release below.

Get Started

Online Pharmacy Prescription Waiver Form

Scotts Valley Veterinary Clinic does not recommend filling any prescription food or medication at a non-veterinary approved pharmacy and cannot guarantee the efficacy or safety of products obtained in this manner.

Online Pharmacy Prescription Waiver

Name(Required)

Please read, sign and initial below. This form only needs to be filled out once for each client (it will cover all pets in the family).

Scotts Valley Veterinary Clinic has prided itself on being a family owned and run business for over 50 years. Therefore, we feel it is of utmost important to notify, warn and clarify assumptions made about the safety of filling your pet’s prescriptions through a non-veterinary approved pharmacy. Veterinary hospitals, veterinary associated online pharmacies and brick and mortar stores have a responsibility to their patient’s, by stocking brand name, well sourced products and store them in appropriate conditions. If a product causes harm and is sourced from a reputable agency then then both the sourcing pharmacy, as well as the manufacturer are liable for any outcome. Unfortunately, this is not the case with many online pharmacies.

Many owners ask us how online pharmacies are able to source medications and prescriptions at cheaper costs than local veterinary offices. To cut costs, many online pharmacies source products from outside vendors, including counterfeit medications which can appear identical to the untrained eye. Many product “toxicities or dangerous side effects” that you may read about online, are often traced back to counterfeit or inappropriately stored products. Online pharmacies have been shown to save money by storing products in overheated or freezing warehouses often leading to product damage and potential toxicity to your pets. Therefore, due to these concerns, most manufacturers only standby/guarantee their products, when they are sourced through a veterinary hospital, a veterinary associated online pharmacy or brick and mortar pharmacies. If a pet has a reaction or dies after receiving a medicated/food from non-approved online pharmacy, neither the non-approved online pharmacy nor the manufacturer are responsible. The non-approved online pharmacy is able to say, the product may have been counterfeit and the manufacturer is able to say that the product was stored inappropriately. It has been discovered that non-approved online pharmacies have forged veterinary signatures, and self-authorized prescriptions to send automatic refills and have even filled prescriptions for deceased pets. We feel it is so important for someone to be liable for the protection and safety of your pets!

We care for and treat our patients like family members. We believe it is our responsibility to research, recommend and carry products that we would consider giving to our own pets. Scotts Valley Veterinary Clinic does not support, recommend or refer clients on a regular basis to any of these large corporate online pharmacies, who care more about their profit that the pets they serve.  We urge you to support your local veterinarian; fill through a veterinary approved online pharmacy or a brick-and-mortar pharmacy, with the purchase of your pet’s veterinary foods and medications.

Many veterinary hospitals are refusing to authorize online prescription requests all together, that will not be the case at this clinic, but we will require that each client initial and sign this waiver of responsibility prior to us authorizing any requests. We can help fill prescriptions still in a variety of ways, we can fill most medications in clinic upon a 24-hour notice, we can authorize any prescription through VetSource pharmacy which can be found through our website, we can call in prescriptions to many brick and mortar stores, or we can provide a written prescription upon request at any time.

Please initial and sign the next page, return it to our email for us to authorize your request.

I hereby request a prescription for a medication(s) and or prescription diet that I intend to purchase through an online pharmacy or catalog vendor. I have been informed that the following risks exist when I obtain these products from such sources, please initial each warning.

I understand, there is the possibility that the prescription medication or food received from these vendors may be counterfeit and may not have been approved by the FDA, USDMA or EPA. This has occurred on multiple documented occurrences in the past and could recur with my pet.(Required)
I understand that any online pharmacy purchased medication or prescription food may results in illness or death to my pet(s)(due to counterfeit sourcing or inappropriate storage) of which, I am waiving all liability and responsibility to the non-approved online pharmacy, the manufacturer of the product and Scotts Valley Vet Clinic.(Required)
I am waiving my right to any manufacturer rebate that is available through Scotts Valley Vet Clinic (usually provided by Scotts Valley Vet Clinic to help make the pricing competitive to the non-approved online pharmacies will not be available to me if I purchase the product online).(Required)
I prefer to give my business to a large corporation with no known relationship to responsibility to my pet or myself rather than a local business. As the provider of your pet’s care, our medical records keep track of all drugs dispensed by us to you. When you purchase your prescriptions elsewhere, our computer tracking system is not able to print instructions for use or risks of adverse effects or to send reminders for follow-up exams and/or lab tests that may be needed to monitor results or adverse reactions.(Required)
I understand, Scotts Valley Vet Clinic is not responsible for the timely delivery of any product from a non-approve online pharmacy related to external/internal parasitism or a medical condition my pet may need immediate treatment for.(Required)
I understand, Scotts Valley Vet Clinic is not liable for an non-approved online pharmacy filling the wrong medication type, size, quantity or administration method (capsules, tablets, liquid). Refills may not accurately reflect the recommendation by your veterinarian.(Required)
I understand that the manufacturer’s warranties or guarantees for these products are not guaranteed if I purchase a product from a non-approved veterinary pharmacy. This means if your pet’s condition is not effectively treated with the product(s) or the pet has an adverse reaction; manufacturers may not stand behind their products or product liability procedures. Additionally, the owners of and doctors at Scotts Valley Veterinary Clinic will be unable to assist you in claims against those manufacturers.(Required)
I have read and initialed the above, accept these 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 Scotts Valley Vet Clinic harmless for any deleterious effects, death or lack of effectiveness of prescription medications or prescription foods purchased from any other source.(Required)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.