Southern Ocean County Animal Hospital

Waiver of Responsibility & Liability

Fill out the Waiver of Responsibility and Liability form online to acknowledge risks associated with third-party pet prescriptions and ensure transparency. Streamline the process before your visit for convenience

Waiver of Responsibility & Liability - Download

Download the form to review and acknowledge risks associated with third-party pet prescriptions. Complete and submit before your appointment.

Southern Ocean Animal Hospital Waiver of Responsibility & Liability

Fill out the form below and we’ll be in touch.

Waiver of Responsibility and Liability for Prescriptions to be Filled by Internet Pharmacies or Catalog Vendors.

Name(Required)
Pet's Name(Required)
Please Check All(Required)
I hereby request a prescription for medication(s) or vaccination(s) for my pet so that I can purchase these products from an Internet pharmacy or catalog vendor. I have been informed that the following risks exist when I obtain these products from such sources.
Signature(Required)
I have read and understand 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 this veterinary practice harmless for any deleterious effects or lack of effectiveness of drugs or vaccines purchased from any other source.