Outside Pharmacy Waiver

CLIENT DETAILS

Client ID

First name

tammy

Last name

clark

k.t.clark272@gmail.com

Phone

8018421054

Patient name

sierra

Patient Information

Please list your pet's names:

sierra

Manufacturer's Guarantee

Many companies only honor product guarantees when a veterinarian prescribes and sells the product. Purchases from unauthorized distributors do not qualify for the same guarantee. Most of our manufacturers do not sell their products to outside pharmacies and do not know where these pharmacy's products are coming from. We can assure you that any prescription medication you purchase from us has been inspected and approved by the Food and Drug Administration (FDA) and has been manufactured and packaged in the United States according to government regulations. If your pet has a reaction to the medication, and it was purchased through our clinic, we can work with the manufacturer to cover the cost of treatment of adverse reactions and/or failure of the medication to cure/prevent disease.

By initialing, you acknowledge that by choosing a written prescription to be filled outside of our clinic, you may be forfeiting manufacturer guarantees and agree to proceed with a written prescription.

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Veterinary Medicine vs. Human Medicine

The majority of human pharmacists get little to no training in veterinary pharmaceuticals and most pharmacists are not knowledgeable about animal physiology. This may lead to pharmacists suggesting changes to your pet's prescription, offering inaccurate substitutions, or may describe a drug’s side effects that relate to humans but do not actually occur in animals. If a pharmacist, retail or online, suggests changing to a different drug or different dosage, please contact us right away before you make any changes. In addition, please inspect the medications filled by an outside pharmacy to confirm the correct medication, dose, and formulation was provided to you.

By initialing, you acknowledge that medications filled outside of our clinic are not overseen by our pharmacy team and agree to consult our clinic before making any changes to your pet’s prescription.

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Current Client/Patient/Veterinary Relationship

Your pet must maintain a current client/patient/veterinary relationship with Midvalley Animal Clinic. A current relationship requires a physical examination of the patient by a veterinarian within the previousvtwelve (12) months in order for any prescription medication to be authorized, whether dispensed by our clinic or prescribed to an outside pharmacy. Certain medications, including controlled substances, may require more frequent examinations in accordance with regulations established by the Utah State Pharmacy Board (USPB) and the Drug Enforcement Administration (DEA).

By initialing, you acknowledge and agree that prescription medications, including refills, cannot be authorized without a current client/patient/veterinary relationship as defined above.

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Written Prescriptions Policy

Midvalley Animal Clinic does not accept faxed, emailed, or electronic prescription requests from outside pharmacies. All outside pharmacy prescriptions require a paper prescription with a handwritten veterinarian signature and must be picked up in person or it can be mailed to their home address. Written prescriptions may be mailed one time upon request for non-controlled medications only. Controlled substance prescriptions cannot be mailed under any circumstances. Once mailed, delivery time is outside the clinic’s control. If a mailed prescription does not arrive, all future written prescriptions must be picked up in person are no longer eligible for mailing. Written prescriptions expire 30 days from the date written and cannot be filled after expiration. Prescriptions are issued with a specific quantity and number of refills, if medically appropriate. Once issued, written prescriptions cannot be altered unless due to a clinic error. Requests to reprocess prescriptions or alter already processed prescriptions such as-change quantities or strengths, switch brands, or transfer prescriptions to another pharmacy may require additional staff time and may result in a technician service fee. If you choose not to fill a written prescription at an outside pharmacy and wish to continue refills through Midvalley Animal Clinic, the original written prescription must be returned. Controlled substances are regulated by state and federal law. Lost or expired controlled substance prescriptions cannot be replaced and cannot be mailed. Non-controlled medications may be rewritten only if the original prescription is returned. A technician service fee may apply.

By initialing, you acknowledge that you have read, understand, and agree to the written prescription policy outlined above and understand that Midvalley Animal Clinic is not responsible for delays, errors, or interruptions related to medications filled by outside pharmacies.

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Alternative Options:

We price match Chewy on all medications! Purchase your pet’s medication directly from our clinic without waiting for outside pharmacy processing or shipping. We have an online pharmacy with no written prescription required! Our team will enter and approve the prescription for you, helping you avoid delays from mailing a paper prescription to an outside pharmacy and waiting for it to be processed. Visit: https://www.midvalleyanimalclinic.com/resources/pharmacy

By signing this waiver, you acknowledge that you have read, understand, and agree to all policies outlined above, including those related to manufacturer guarantees, outside pharmacies, written prescriptions, and current client/patient/veterinary relationship requirements. You accept responsibility for medications obtained from outside pharmacies, including any delays, dispensing errors, or loss of manufacturer guarantees, and agree to comply with these policies as a condition of receiving a written prescription.

Please sign here

Date