Consent for Off-Licence Use of Medicinal Product Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Owner Name *FirstLastAddress *Telephone Number(s) *Pet's Name *BreedSpecies *Age (years) *Age (months)Off Licence Medication(s) Medication(s) Off Consent Sex *— Select Choice —Male EntireMale NeuteredFemale EntireFemale NeuteredOff Licence Consent *I am over 18 years of ageI understand that while the animal described above is under the care of this veterinary practice there may be occasions when it will be necessary to use authorised human and veterinary medicines not authorised for the use in your pet’s species or which are authorised for use in this species but not for the particular condition for which the treatment will be given. I have been made aware that there may be known and unknown side effects associated with the use of these drugs and, in giving permission for their use, accept any attendant risks. Digital Signature or Owner or Agent – Name *FirstLastBy signing this form, I understand that I am accepting the terms and conditions of business which are set out above.Date *Email *Submit Consent Form
