RELEASE/DISCLAIMER

 

 

 

1) I hereby state that I am at least eighteen years of age and I am fully competent to make my own health care decisions.

 

2) I understand that it would be a violation of the law to falsify information on my medical questionnaire.

 

3) I state that I have had a physical examination by the physician whose care I am under within the last 12 months.

 

4) I understand that it is my responsibility to have regular physical examinations by the U.S. licensed physician whose care I am under including all suggested testing by said physician to ensure I have no medical problems, which would constitute a contradiction to me taking the medications being prescribed for me.

 

 

1) I will only use the medication as prescribed.

 

2) I will not allow anyone else to use my medication.

 

3) I acknowledge I may not return any medication dispensed to me.

 

4) I am aware of the potential side effects and/or problems associated with prescription medications.

 

5) I am not seeking medical advice or treatment of any kind whatsoever and I am dealing with RxEstore and its pharmacies for the sole purpose of obtaining medication.

 

6) If necessary, RxEstore or one of their pharmacies or one of its authorized representatives may contact me or, my physician for more information. I hereby give permission to my physician to release my medical files and medical reports as needed to obtain sufficient information for the purpose of prescribing my medications.

 

7) I understand that this service should not be considered a substitute for a health care provider. I understand that this service is not in any way intended for the diagnosis of a medical condition. I understand that RxEstore, or any of its pharmacies, or its authorized representatives, will not make any medical diagnoses and that the RxEstore web site should not be used as a substitute for professional medical advice.

 

8) I will direct all questions to my own health care provider. I will consult my own physician before taking any new drug or changing my daily health regimen.

 

 

1) I hereby acknowledge that the prescription I wish to obtain was originally prescribed by my personal doctor.

 

2) I agree that should I suffer any adverse effects while taking these prescribed medications, that I will immediately contact my licensed physician whose care I am under.

 

3) Any and all questions that I have about my prescription medications and their associated risks have been answered to my satisfaction.

 

4) Should I come under the care of another physician, I will inform him or her of any and all medications I am taking which have been prescribed.

 

5) I understand that RxEstore and its pharmacies will only verify medications that my licensed physician (whose care I am under) has already prescribed to me.

 

6) I understand that RxEstore and its pharmacies reserve the right to refuse to fill any prescription order that they deem invalid or questionable.

 

7) I understand that prescription prices appearing on the web site are subject to change without notice.

 

D.                 The Release

 

1) I release and discharge RxEstore and its pharmacies, including all of their employees and contractors including pharmacists, pharmacy technicians, physicians, nurses, and receptionists from any and all liability whatsoever associated or connected to my medical consultation and the use of any and all of the medications prescribed to me and any adverse effects I may suffer from these medications.

 

2) I understand the risks of taking medication and I understand that all of the possible risks and/or complications that may occur may never have been recorded before.

 

3) By signing this Patient Release/Disclaimer and/or by clicking “I AGREE” (if being submitted electronically), I agree to release liability and hold harmless the physicians, affiliates, directors, officers, employees, representatives, and independent contractors (RxEstore) from all causes of action, suits, penalties, liens, judgments, liabilities, obligations, losses, actual or consequential damages and actual or threatened claims which may arise at any time by reason of relating to, arising directly or indirectly out of any matter whatsoever related to the prescribing or dispensing of my prescription medications.

 

4) I understand that any options, advice, statements, services, offers, or other information expressed or made available by third parties (including merchants and licensors) are those of the respective authors or distributors of such content.

 

5) I understand that RxEstore and its pharmacies reserve the right to change this Patient Release/Disclaimer and the medical consultation form at any time.

 

E.                  Disputes

 

1) I agree to the jurisdiction of the Province where the managing pharmacy maintains its offices, meaning that any dispute that arises between the managing pharmacy and me will be governed by the laws of that Province and any applicable federal laws of Canada; and

 

2) If any dispute does arise between any of the pharmacies and me about rights or liabilities arising from the purchase of my medication that cannot be resolved on the basis of both sides acting reasonably, then such dispute shall be referred to arbitration in the Province where the managing pharmacy maintains its place of business.

 

This agreement represents the complete and entire agreement between RxEstore, its participating pharmacies and me. I have read and understood the above-referenced “Patient Release/Disclaimer”. I declare that I understand all the terms and conditions herein.