WHAT'S NEXT?
1.	Each prescription is reviewed by a licensed and professionally registered veterinarian.
2.	Prescriptions are filled by a licensed Canadian pharmacist and sent to your home.
PET MEDS CHECKLIST
I have completed pet information form I have signed the consent form I have a witness signature on the consent form My pets prescription(s) are less than 2 months old I am aware that it may take 3-4 weeks to receive my order*
	CHARGES - 3-month supply with three-month refill - no restriction on number of prescriptions. * If your order is canceled after the doctor review and before it is shipped, we will assess a $20 administrative fee. Once an order has been shipped, there is no cancellation. All sales are final.
Please Note: CanadaWayDrugs facilitates the review of your pet's prescriptions and medical health by a licensed Canadian veterinarian and forwards all prescriptions to an affiliated CIPA certified licensed Canadian pharmacy to be filled. Prescriptions are currently dispensed by the following CIPA-certified pharmacy: Coastal Canada Pharmacy #1006-7495 132nd Street Surrey, BC Canada V3W 1J8 Licensed in British Columbia by The College of Pharmacists of British Columbia Pharmacy Manager: Grace Kim (License# 08001)

CanadaWayDrugs.com Suite #548 102 - 17750 56th Avenue Surrey, BC Canada V3S 1K4 Toll Free Phone: 1-877-507-3061 Toll Free Fax: 1-866-308-2272

Pet and Owner Information:

Pet Name: __________________________ Species (and breed): _________________________

Age of Pet:___________________Weight:____________Gender:_______M________F

Allergies (if no, write "NONE"): _____________________________________________________

Known Medical Conditions:________________________________________________________

Spayed or Neutered:_____________________________________________________________

Vaccination History:______________________________________________________________

List other medications pet is currently taking:_________________________________________

Owner: _______________________________________________ DOB:____________________

Phone Number:(____)_________________ Secondary Phone Number:(____)_______________

Home Address:____________________________________________________Apt:__________

City: __________________________ State: ___________________ZIP Code: ______________

Email:____________________________     KEYCODE:_________

Veterinarian Information:

Last Name:_________________ First Name: _____________________

Address: ____________________________________________

City: ______________________ State: _____________________ZIP Code: ______________

Telephone: (_________________)* Fax: (__________________ )* REQUIRED

Please Note: We do not usually ship medications in child-proof containers. If you require child-proof containers, please indicate by checking here _____

How did you hear about us?___________________________________________________________

Is this your first time ordering from CanadaWayDrugs?____ Yes ____ No

I understand that I am ordering from an international pharmacy and that once the pharmacy ships my medications, all sales are final. We are unable to take returns.

Consent and Waiver of Liability Form

I ____________________ of the city of ________________ in the state of ___________ have read, understood and agree to the following:
1. I, __________________ am not seeking medical advice or treatment of any kind whatsoever in coming to CanadaWayDrugs and its physicians, veterinarians, employees, officers, agents and all others acting through or for it.
2. Neither CanadaWayDrugs, nor any of its physicians, veterinarians, employees, officers agents and all others acting through or for it, or anyone that is acting on its behalf, is providing medical advice, professional advice, treatment advice or treatment of any kind whatsoever to me or my pet.
3. I am coming to CanadaWayDrugs for the SOLE PURPOSE OF OBTAINING A PET PRESCRIPTION AT A LOWER PRICE THAN IN THE UNITED STATES OF AMERICA. I understand that no one on behalf of CanadaWayDrugs will take any steps whatsoever to determine whether the prescription is appropriate.

I _________________ hereby acknowledge that this prescription was originally prescribed by my pet's American veterinarian whose name is __________________________ and that I will continue to have my pet's medical condition and medications obtained in Canada monitored by my pet's American veterinarian upon my return to the United States of America.

I, ________________ have given the authority to CanadaWayDrugs to act as my agent and/or representative to facilitate the purchase of prescription medicine from a licensed Canadian pharmacist.

In consideration of approving this prescription and in consideration of CanadaWayDrugs making this prescription, I agree not to sue CanadaWayDrugs, its physicians, veterinarians, employees, officers, agents and all others acting through or for it, and release CanadaWayDrugs, its physicians, veterinarians, employees, officers, agents and all others acting through or for it, from all legal liability for any problems associated with the prescription.

I hereby agree that the relationship between and the resolution of any and all disputes arising between me and CanadaWayDrugs, its physicians, employees, officers, agents and all others acting through or for it, shall be governed by and construed in accordance with the laws of the State of Washington, U.S.A.
I hereby acknowledge that the Courts of the State of Washington shall have jurisdiction to entertain any complaints, demands, claims or cause of action, whether based on alleged breach of contract or alleged negligence arising out of the signing of this prescription, and I hereby agree that I submit irrevocably to the exclusive jurisdiction of the Courts of the State of Washington.

All of which is agreed.

Printed Name: __________________________________
Signature:_________________________________ Date: __________________
Printed Name of Witness: __________________________________
Signature of Witness __________________________Date: ___________________
Relationship of Witness: ________________________________________________

Fax, mail or scan the pet information forms along with the prescriptions to:

CanadaWayDrugs.com Suite #548 102 - 17750 56th Avenue Surrey, BC Canada V3S 1K4 Toll Free Phone: 1-877-507-3061 Toll Free Fax: 1-866-308-2272