CURES

CURES

Controlled Substances Authorization
South Bay Veterinary Hospital
The following agreement relates to your pet's use of a controlled substance prescribed by a licensed veterinarian of South Bay Veterinary Hospital.

CURES is a database of Schedule II-VI controlled substances prescribed in the state of Califorinia. It was established by the Drug Enforcement Agency and Department of Justice in 2006 to reduce prescription drug abuse and diversion withoiut affecting lefitimate medical practice or patient care. California Law (Health and Safety Code 11165.1) requires us to report all controlled substances dispensed and provide specifued dispensing information to the Department of Justice on a weekly basis.

If the licensed veterinarian recommends a controlled substance for you pet's condition, these regulations must be met:

1. Owner's date of birth must be provided (Must be 18 years or older)

2. By law, a maximum of thirty days supply of medication will be prescribed at any one time.
Pet Name:   *   Date:*
First Name*   Last Name*

  Signature:*

Date of birth of Client/Owner:   Date of birth of owner/Client: *
I decline to give information and understand that my pet will not be dispensed any controlled substances. Please sign below, if your wish to decline.

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South Bay Veterinary Hospital