I accept, understand, and agree to
the following: I am freely seeking medical consultation
via the Internet and I am aware that the physician
reviewing my medical history will not have the opportunity
to conduct a personalized in-person physical examination;
I am soliciting this site because I am seeking
a specific prescription medication to treat an already-identified
medical or cosmetic condition;
I understand that my "Medical History
Questionnaire" will be reviewed by a physician who
is licensed in the U.S. I acknowledge and agree
that I, under no undue duress, initiated contact
with PharmaPillsRx.com. I am aware that my prescribing
physician may be located in another state or country
other than my own and that said physician may NOT
be licensed to practice medicine in my state of
residence (referred to as the ("Consulting Physician");
I AGREE THAT ALL ON-LINE MEDICAL CONSULTATIONS,
DIAGNOSES, AND TREATMENTS WILL BE DEEMED TO HAVE
OCCURRED IN THE STATE WHERE THE PHYSICIAN IS "PHYSICALLY"
LOCATED AND LICENSED TO PRACTICE MEDICINE.
I am under the care of a primary care
physician and I do not consider the Consulting Physician
to be my primary care physician (unless I visit
said physician for an in-person personal doctor/patient
consultation). I will not rely on or substitute
the advice given by the Consulting Physician should
it contradict the advice given to me by my primary
care physician;
I will not make a claim that the Consulting Physician
acted unprofessionally or below the standard of
care solely because the physician did not personally
perform a physical examination on me;
The Consulting Physician reviewing
my "Medical History Questionnaire" will make a decision
based upon my honest responses in making his or
her decision regarding my request. I understand
each question I answered on the questionnaire was
responded to truthfully, accurately and completely.
I also understand that failure on my part to provide
truthful, accurate and complete information to the
Consulting Physician could cause him or her to unknowingly
make an inappropriate treatment decision affecting
my physical or mental health. To prevent this occurrence,
I acknowledge that it is of utmost importance that
I am truthful when answering the questions asked
in the "Medical History Questionnaire";
Before taking any medication prescribed, I will
ensure that I have completed the following: accurately
and honestly completed a comprehensive physical
examination by my primary care physician; that I
received a copy of the written report of said examination,
and that I have identified my responses to the "Medical
History Questionnaire" any findings from my physical
examination that are not within the accepted average
range;
PharmaPillsRx.com does not practice
medicine. I understand that PharmaPillsRx.com is
a Management Service Organization that received
my request for a physician consultation and, in
turn, directs that request to a qualified independent
physician for review and response. The physician
who reviews my medical history and who makes the
medical determination as to whether or not I receive
the medication I am seeking is solely an independent
contractor of PharmaPillsRx.com and is not an agent
or employee of PharmaPillsRx.com or its affiliates.
PharmaPillsRx.com does not direct, control or influence
the treatment decisions made by the Consulting Physician
with respect to my care and/or my request from PharmaPillsRx.com
is not liable for any negligent act or omission
of the Consulting Physician;
I understand that my medical record becomes the
property of the Consulting Physician or PharmaPillsRx.com,
and that, in addition, PharmaPillsRx.com will have continuing
access to and the right to copy and retain any and
all portions of my medical record;
I am over 18 years of age;
I am soliciting this site to determine
whether or not I fit the criteria for certain prescription
medications. I am not currently seeing my regular
primary care physician at this time because: a)
this site is more convenient, b) for other personal
reasons;
I agree that any dispute arising out of or related
to the provision of services by the Consulting Physician,
by PharmaPillsRx.com, its affiliates, or their employees,
partners and agents, shall be subject to mandatory
mediation. Should mediation fail to resolve the
disputable issue(s), said dispute shall be subject
to final and binding arbitration, as set forth in
the United States Arbitration Act.
In accordance with the United States
Arbitration Act, I agree that any dispute arising
out of or related to the provision of services by
the Consulting Physician, by PharmaPillsRx.com,
its affiliates, or their employees, partners and
agents, shall be subject to final and binding arbitration
exclusively through the Procedures of the American
Arbitration Association. I understand that this
agreement is voluntary and that it is binding to
any individual or entity claiming by or through
me or on my behalf; and I chose this site on my
own accord from several Internet options;
Any mediation, arbitration, administrative proceeding,
complaint, court proceeding, or other proceeding
pertaining in any way to this site must be held
in the County of Nevada, City Grass Valley, and
in no other forum in any other place. This Informed
Consent expressly includes knowing consent to transfer
the venue of any dispute of any kind to the above
city and county for resolution.
I hereby release PharmaPillsRx.com
and the Consulting Physician from all claims that
the Consulting Physician acted unprofessionally
or below the standard of care solely because he/she
did not perform a physical examination on me.
This release includes, but is not limited to, my
agreeing to the following:
I have truthfully answered all of
the questions and have provided complete and accurate
answers to the questions. I further agree to make
the PharmaPillsRx.com physicians aware of any changes
in my medical condition in the event I revisit this
site to obtain more or different medication;
I am aware of potential side effects associated
with this medication. I personally accept all risks
involved in taking medication and will not seek
any indemnification, any damages of any kind, or
any other liability from PharmaPillsRx.com, its parent,
subsidiaries, affiliates, contractors, or partners,
if I experience any of the side effects;
I understand that no doctor, nurse,
or administrative personnel can guarantee that the
prescription medicines I am requesting will provide
the results I seek;
It is my responsibility to have an annual physical
examination, including any suggested laboratory
tests, to ensure that I do not have a condition
which will make my taking this medication inappropriate
or dangerous;
I have consulted with my physician
and/or pharmacist and am not currently taking any
medications or combination of medications that will
make the medication I am requesting inadvisable
to take (contraindicated); and, I will notify my
primary care physician that I am taking the medication
that I requested so that he/she may advise me as
to whether or not I should continue or discontinue
its use.
This document also serves as my informed consent
to allow PharmaPillsRx.com access to any of my medical
information, including all medical data contained
in the "Medical Records Questionnaire" including,
but not limited to, any health information regarding
HIV, mental health, alcohol, drug or substance abuse
conditions or treatments ("Medical Information").
I hereby authorize my Physician to release or disclose
to PharmaPillsRx.com any and all Medical Information.
I accept that, with the exception for action formerly
taken with regard to this authorization, I can void
this authorization at any time by providing notices
to PharmaPillsRx.com or to the Consulting Physician. This
consent does not give PharmaPillsRx.com, its parent or
sister companies, the right to sell my name or information
to any third party.
In consideration of PharmaPillsRx.com's
undertaking to render the undersigned patient any
administrative or any other services relating in
any way to this agreement, or PharmaPillsRx.com
disclosing information or methods of treatment to
patient (either of which are deemed sufficient consideration
for this agreement) then, in the event any court
determines that the undersigned patient sought medical
treatment or medical prescriptions through PharmaPillsRx.com
for the possible or apparent purpose, directly or
indirectly, of deception, assisting any investigation,
or rendering of any type of assistance to, or disclosing
of any information pertaining to PharmaPillsRx.com,
its procedures, officers, directors, or medical
protocols, to any news organization, possible or
actual competitor, any type of governmental agency,
any investigator or any party for possible or apparent
purposes of securing any information, confidential
or otherwise, about PharmaPillsRx.com, its officers,
directors, shareholders, affiliates, banking relationships,
contractors, medical laboratories, contracting physicians,
medical protocols, sources of pharmaceuticals, proprietary
medical treatment protocols or PharmaPillsRx.com's
system of pharmaceuticals procurement and dispensing,
then the undersigned patient knowingly, expressly
and irrevocably consents to a judgment in favor
of PharmaPillsRx.com, its officers, or any party
proceeding under the authority of this instrument,
of liquidated damages, jointly and severally against
the undersigned patient, as well as any express
or apparent principle (including patients employer)
as an authorized or apparent agent of his/her principle
or employer, in the amount of Three Million Dollars
($3,000,000.00), which liquidated damage amount
is hereby accepted by the undersigned as a reasonable
amount for engaging in such acts of deception and
because they are difficult to ascertain. The undersigned
patient engaged in such deception or any of the
above described acts, agrees on behalf of himself
and his/her principle, to pay all reasonable attorneys
fees and costs incurred by any person or entity
seeking to enforce this agreement. This agreement
represents the complete and entire agreement between
the parties to it.
I understand that all prescription medications
purchased cannot be refunded.
ALL INFORMATION, ITEMS, AND SERVICES
CONTAINED ON THIS WEB SITE ARE PROVIDED "AS IS"
WITHOUT WARRANTY OF ANY KIND, EXPRESSED OR IMPLIED.
IN USING THIS WEB SITE, I UNDERSTAND AND AGREE;
(A) THAT PharmaPillsRx.com IS NOT RESPONSIBLE FOR THE
NEGLIGENT OR INTENTIONAL ACTS OR OMISSIONS OF ANY
HEALTH CARE PROVIDER OR SUPPLIER THAT I MAY BE LINKED
WITH OR FOR ANY ACTION OR INACTION TAKEN BY ME IN
RELIANCE UPON THE INFORMATION COMMUNICATED TO ME
VIA THIS WEB SITE; (B) THAT THE TOTAL LIABILITY
OF PharmaPillsRx.com AND ITS AFFILIATES, IF ANY, ARISING
FROM OR RELATED TO INTERACTIONS I HAVE WITH OR THROUGH
THIS WEB SITE (WHETHER THE CLAIM IS CONTRACT, TORT,
WARRANTY, NEGLIGENCE, MALPRACTICE, FRAUD, OR OTHERWISE)
IS LIMITED TO THE PURCHASE PRICE OF ANY PRODUCTS
IN ANY RELEVANT TRANSACTION AND (C) THAT PharmaPillsRx.com
SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL,
INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES.
IN ACCORDANCE WITH THE ABOVE UNDERSTANDING,
I AGREE TO RELEASE PharmaPillsRx.com, THEIR EMPLOYEES,
AGENTS, CORPORATE AFFILIATES AND RELATED PARTIES
FROM ANY AND ALL LIABILITY ASSOCIATED WITH OR ARISING
FROM THE PHYSICIAN CONSULTATION OR FROM THE MEDICAL,
PHYSICAL, BEHAVIORAL OR OTHER EFFECTS OF ANY MEDICATION
THAT MAY BE ORDERED, PRESCRIBED OR PURCHASED AS
A RESULT OF THE PHYSICIAN CONSULTATION.
IF ANY PROVISION OF THIS ABOVE AGREEMENT IS HELD
TO BE VOID, UNENFORCEABLE OR ILLEGAL, THEN I AGREE
THAT THE AGREEMENT WILL BE CHANGED OR LIMITED ONLY
TO THE EXTENT NECESSARY TO ENABLE THE REMAINING
PROVISIONS TO BE OF FULL FORCE AND EFFECT.
PharmaPillsRx.com Disclaimer and User Policy - Please
note that PharmaPillsRx.com does not actually prescribe
or sell any of the medications that are shown on
this website. PharmaPillsRx.com is only an advertising
website. We provide links for our users to visit
on their own accord. When a user leaves the PharmaPillsRx.com
website, they are responsible for any actions that
they take from that point. PharmaPillsRx.com recommends
that you check your local laws to ensure that you
are not breaking any regulations by ordering certain
types of medications from certain locations. PharmaPillsRx.com
caters to an international audience. Therefore,
certain medicines may be listed on this site that
are legal in one country but not in another. In
any case, PharmaPillsRx.com recommends that you
consult with your doctor before you buy or use any
of the medications that are listed online. As an
information provider, PharmaPillsRx.com cannot be
held accountable for the contents of the websites
that we link to. If you have questions about the
websites that you visit after leaving PharmaPillsRx.com,
please refer your questions to the site owners that
are responsible for their own content.