Prescription Waiver Form – Happier at Home Mobile Veterinary Hospital

Owner's Name*
First Last
Today's Date:*
Date Format: MM slash DD slash YYYY
Phone #:*
Email:*
Pet's Name:*
Species:*
Consent
I agree and understand.
I, the undersigned, hereby state that I am the [legal owner/legally authorized representative of the legal owner] of the above-listed pet and authorized to make all medical decisions regarding this pet. I have declined filling medication(s) through Vets First Choice or other approved pharmacies. I hereby remove Dr. Tamie Haskin and Happier At Home Mobile Veterinary Hospital from any liability related to non-veterinary approved products. I authorize Happier At Home Mobile Veterinary Hospital, at my request, to provide written prescriptions, online authorizations, and/or phoned-in prescriptions for the above-listed pet. I understand that there are fees related to this policy and that they are due immediately upon request of a prescription(s).
By submitting this form, I agree that I have read and understand this authorization and hereby accept and agree to the terms.
Please click the "Submit" button when the form is complete.

Reach out to us and we will be happy to answer any questions, discuss your pet’s health and book an appointment.

P.O. Box 89
Bel Air, MD 21014

Monday – Friday:
9:00 am – 5:00 pm
Saturday:
Dental Procedures by appointment only
Sunday:
Closed

By submitting this form, I agree that I have read and understand this authorization and hereby accept and agree to the terms.