By ordering products from (), I, the requestor, confirm the following statements to be true and complete, as if I am placed under oath and subject to penalties of perjury:
I am at least 18 years old and an adult capable of entering legal contracts.
The laws in my geographical address permit the delivery of the requested medication(s).
All questions asked of me during the medication request in this website have been answered truthfully and completely.
I will not distribute or sell the requested medication(s) to others.
I have had a recent physical examination by a licensed medical physician. Based on the results of my physical and medical history, my doctor has informed me that I have no problems in using the requested medication(s).
I know that all medication(s) have certain risks and I am ready to seek medical attention should I encounter them.
I will contact my doctor for medical assistance in case I have any complications, issues, or questions regarding the requested medication(s).
Knowing all the risks associated with the requested medication(s), I consent to treatment.
I understand the benefits, side effects, and risks of the requested prescription medication(s). I have read additional literature about this and have no additional questions.
I have used the requested mediation(s) in the past while under a licensed doctor's supervision. My doctor has advised me that the requested medication(s) is appropriate for my condition.
I am requesting prescription medication for my own personal medical purposes only.
I request that a US Licensed Medical Doctor assist my Local Medical Doctor by prescribing the requested medication(s).
I request the prescribing doctor to allow the fulfilment of the requested medication(s) by a US licensed pharmacy.
I do not request the prescribing doctor to replace the opinion of my local physician.
I am requesting just the needed amount of medication(s) for my condition and I am not attempting to create a reserve, or stockpile of medication.
I will not take any other medication(s), including "over-the-counter" medication, without prior consultation and approval from my pharmacist.
I am the authorized cardholder of the credit card used for payment of the requested medication.
I have provided all pertinent information concerning my health and medical history so that the pharmacist and prescribing doctor may properly review my request for medication.