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AUTHORIZATION FOR OFF-LABEL DRUG USE
CATOCTIN VETERINARY CLINIC Owners Name ________________________________________________________ Date ______________________________________ Address ______________________________________________________________________________________________________ Number to be reached at __________________________________________________________________________________________ Animal’s Name _________________________________________________________________________________________________ Species ____________________________________________ Breed ________________________ Color ________________________ Age _______________________________________________ Sex _________________________ Weight _______________________ I, being responsible for the above described animal, have the authority to grant you my consent to receive, prescribe for and treat my pet.I understand that the use of the described medication in the treatment of my animal constitutes off label use. This is defined as “actual or intended use of a drug in a manner that is not in accordance with the approved labeling” and is used in this instance to either describe the use in a species not listed in the labeling or for indications not listed in the labeling. Many human approved drugs are commonly used in veterinary medicine that have not been approved for use in veterinary patients but for which no species approved product is available. Please refer to the attached sheet of specific drug related precautions and potential side effects. You are to use all reasonable precautions against injury of my pet, but you will not be held liable or responsible in any manner in connection therewith as it is thoroughly understood that I assume all risks. After carefully reading the above, I have signed in agreement. |