Skip to content
For Dogs · WOOPF™, opens in a new tabCare about your pet? Download ASK A VET!For Cats · PURRZ™, opens in a new tab
ASK A VET

Off-Label Medication Consent Form

A free fillable consent form for off-label (extra-label) medication use, for veterinary practice. Record the medications, sign on screen, then print or save as a PDF. Patient and owner details are never stored or sent anywhere.

Clinic

Clinic Details

Client

Client's Details

Patient

Patient's Details

Off-label

About Off-Label Use

Many medications used in veterinary medicine are used "off-label". This means the use falls outside what the product is registered for: a different species, condition, dose, route, or duration, a human-registered product, or a compounded preparation. Off-label use is common, and lawful when directed by a veterinarian, but registered safety and efficacy data may be limited for this particular use and side effects may be less predictable than for on-label use.

Medications

Medications

Medication 1

(side effects discussed, monitoring, withholding periods)

Consent

Consent

I understand that the medication(s) listed above are being used off-label for my animal, and the veterinarian has explained why this use is recommended, the expected benefits, and the possible side effects. I agree to give the medication(s) only as directed, to monitor my animal, and to contact the clinic promptly if I see unexpected signs or side effects. If this animal is a food-producing species, I understand that withholding periods apply as directed by the veterinarian and that produce from this animal must not enter the food chain during them. I confirm that I am over the age of 18 years and am the owner, or an authorised agent of the owner, of this animal.

Owner / agent signature
Veterinarian signature
Preview

Off-Label Medication Consent Form

Live preview · prints exactly like this

Off-Label Medication Consent Form

Clinic Details

Date

Client's Details

First name
Last name
Phone
Email

Patient's Details

Name
DOB (age)
Microchip
Weight (kg)
Gender
Species
Breed
Food-producing species?

About Off-Label Use

Many medications used in veterinary medicine are used "off-label". This means the use falls outside what the product is registered for: a different species, condition, dose, route, or duration, a human-registered product, or a compounded preparation. Off-label use is common, and lawful when directed by a veterinarian, but registered safety and efficacy data may be limited for this particular use and side effects may be less predictable than for on-label use.

Medications

Medication (brand and active ingredient)StrengthDose and routeFrequency and durationReason for use (indication)Why this use is off-labelNotes

Consent

I understand that the medication(s) listed above are being used off-label for my animal, and the veterinarian has explained why this use is recommended, the expected benefits, and the possible side effects. I agree to give the medication(s) only as directed, to monitor my animal, and to contact the clinic promptly if I see unexpected signs or side effects. If this animal is a food-producing species, I understand that withholding periods apply as directed by the veterinarian and that produce from this animal must not enter the food chain during them. I confirm that I am over the age of 18 years and am the owner, or an authorised agent of the owner, of this animal.

Owner / agent name
Date signed

Owner / agent signature

Prescribing veterinarian
Registration number

Veterinarian signature

Built by Dr Duncan Houston for Ask A Vet · askavet.com

Nothing typed into this form is sent to or stored by askavet.com. All data stays in your browser and leaves only in the PDF or printout you create. Off-label prescribing rules differ by jurisdiction and species, especially for food-producing animals. The prescribing veterinarian is responsible for the recommendation and directions recorded on this form.

Dr Duncan Houston
About the author

Dr Duncan Houston · BVSc, Veterinarian

Emergency careGeneral practiceMobile vet careFounder, ASK A VET™

Dr Duncan Houston is an Australian veterinarian with experience in emergency, general-practice and mobile veterinary care. He is the founder of ASK A VET™. This guide is educational and is not a substitute for hands-on veterinary care.

When Remember is on, this page saves your clinic's details in this browser only. Owner and patient details are never saved. It is never sent to Ask A Vet. Use Forget to remove them from this computer.