Waiver of Liability of Outside Prescriptions Form

Gently acknowledge the considerations when obtaining pet prescriptions online through Star Veterinary Centers.

Waiver of Liability of Outside Prescriptions Form

Kindly complete the form, ensuring all details are filled, and sign to confirm your understanding.

Waiver of Liability of Outside Prescriptions Form

"*" indicates required fields

I, the undersigned, have requested a prescription to purchase products from an online pharmacy not associated with Star Veterinary Center. Upon signing, I acknowledge that I have read, understood and agree to the statements below.

Outside pharmacies manufacturer warranties/guarantees are not guaranteed by Star Veterinary Center and the practice is not responsible and holds no liability to enforce them.
Rebates through Star Veterinary Center will not be available for my purchase.
There is a possibility that prescription products purchased online or from an outside source may be; counterfeit, stored improperly, be outdated or near expiration and/or contain contaminants or ingredients not approved by the FDA.
Star Veterinary Center accepts no responsibility for any financial or medical liability incurred from online purchases, not affiliated with our practice.
Star Veterinary Center is not responsible for any mistakes made by the pharmacy of my choosing. This includes but is not limited to; improper dispensing errors, billing, shipping or any other type of fraudulent/misleading acts.

Owner’s Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Pet’s Information

Pet's Name*

Species*

Breed*

Sex*

Date of Birth / Age*

Untitled*

I have read, understand, and accept the risks associated with purchasing from an outside pharmacy.

Owner/Agent's Signature*

Date*

Comments

This field is for validation purposes and should be left unchanged.

Waiver of Liability of Outside Prescriptions Form

Waiver of Liability of Outside Prescriptions Form

Waiver of Liability of Outside Prescriptions Form

Owner’s Information

Pet’s Information

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