Online Pharmacy Waiver of Responsibility and Liability Client* First Last Pet's Name*I hereby request a prescription for purchase from an outside online pharmacy or catalog vendor not associated with Mahomet Animal Hospital. I have been informed that the following risks exist when I obtain these products from such sources. There is no way for my veterinarian to know if the product has been stored properly while in transit, is out of date, repackaged, or counterfeit when purchased from an outside online source. Many of these sites are operating illegally, from foreign countries where medications are shipped here with no governmental monitoring. 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. 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. Most drug manufacturers will not warrant safety, purity, or efficacy when marketed through these sources. However, if purchased through a licensed veterinarian, warranties are honored. Mahomet Animal Hospital cannot take responsibility for the safety of drugs purchased through an online pharmacy. Manufacturer rebates and sample products that would normally be available for products purchased through our facility will not be honored when purchased from outside online pharmacies or catalog vendors.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 Mahomet Animal Hospital and its associated staff will be held harmless from the use of products and/or prescriptions purchased from sources outside the hospital’s monitoring control.Consent* I have read and understand the above risks.Client or Authorized Agent Digital Signature*Printed Name*Date* MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.