I affirm and state truthfully as if I was under oath that:
- I am at least 18 (eighteen) years of age and an adult of sound mind and judgement.
- I am permitted by the laws in my country to receive the treatment and/or medications that I have requested.
- The prescriptions and medication(s) that I have requested are for my own personal medical and/or therapeutic purposes. The prescriptions and medication(s) that I have requested represent an actual necessary supply of medication and will not exceed an already adequate personal supply nor will they be used in any way to supply any third party.
- I have had a recent medical examination, including a medical history evaluation, both of which were found to be satisfactory by a registered physician.
- I affirm that my local physician is available for any necessary (local) follow-up care, consultation and for any intervention if the need arises. I affirm to contact him/her immediately in the event that I should experience any problems or complications regarding the treatment and/or medication(s) or if I have any (other) concerns regarding the treatment and/or medication(s).
- In completing this consultation and request for treatment(s), I request a registered EU prescriber to act as an adjunct to my own local physician and, when reviewing my request, not to replace my local physician.
- I accept and appreciate that the evaluating doctor or his duly appointed representative may contact me by email to clarify any outstanding issues with me or to advise me regarding my request. I also know that I may contact the prescribing physician and the dispensing pharmacy, for which I will use the website’s contact form to arrange for a return phone call.
- I authorise the prescribing physician to submit any prescription he chooses to issue for me to an EU licensed pharmacy of good standing, to avoid any delay in shipping the goods to me.
- I accept there is no guarantee that the medication requested by me will have the effects that I desire.
- I understand that there are benefits as well as risks to any medication, even if its application was or has been approved by a physician. I understand that such risks include side effects (which may be serious), possible drug interactions with other medication(s) or unexpected results. These risks have been explained to me in detail by appropriately trained health care personnel. Also I have studied written and online materials on these drugs and or treatments, including the current official product information being published by the drug manufacturer.
- I will inform my local physician and pharmacist about medications which I will request through this website. I understand that full disclosure is essential for my personal health and safety.
- I agree not to take any other medication(s), not even prescription-free drugs, without first consulting a pharmacist or medical practitioner. In any such consultation, I agree to present to him/her a complete list of medications that I am taking, including all treatment(s) that may or will result from my request(s) through this website.
- I agree to monitor my blood pressure at least once every 14 (fourteen) days. If my blood pressure is higher than 140/90 (either the top number is greater than 140 or the bottom number is greater than 90), I will stop taking the requested medication right away and I will contact a doctor immediately.
- I understand that every detail relating to my health (actual as well as from the past) might be relevant to my request(s) treatment(s) and or medication(s) as well as for my personal safety.
- At all times I will fully and completely disclose any and all information relating to my health and medical history, regardless of whether I think it is important for the medical assessment or not. In doing so, I will at least provide all information as if the consultation had taken place with any (local) physician in a physical office setting.
- I affirm that I have answered and will answer all questions truthfully and to the best of my ability. I have in no way omitted or misrepresented any statement or fact.
- I understand that it is in my area of responsibility and interest to have regular medical examinations including proposed laboratory tests to ensure that I have no diseases that could exclude the safe use of the treatments that I have requested (so called “known contraindications” ).
- I have not been forced in any way to undergo treatments and or to request any medications. I do so out of my own free will and choice.
- I am allowed by law to use the credit card and or any other payment method that I will use to purchase the medication(s) or treatment, if my request is approved and processed. I understand that credit card fraud is a criminal offense.
- I understand that I can abort my request at this point, without any obligations whatsoever, should I be in any doubt about the requested therapy, this website, its terms and conditions and or this agreement.
- I confirm that I have fully and completely understood this Patient Responsibility Agreement. I agree that by proceeding with this request and by voluntarily agreeing to this agreement, that I irrevocably bind myself to the terms and conditions contained herein.
