Declaration

By submitting this order form, I hereby certify that:

• I am at least 21 years of age.
• I am permitted by law in my locale to receive the medication(s) I am requesting.
• I, the patient, have had a recent physical examination and medical history evaluation by a physician who is available for any necessary local follow-up care and intervention.
• I have been fully informed and understand the risks, benefits, and possible side effects of the prescription drug(s) I may request,
• I safely used the medication(s) I may request under a physician's supervision or been advised be an examining physician that the use of the medication(s) is not contraindicated for me and is appropriate for my therapeutic and medical needs.
• I am requesting the prescription medication(s) solely for my therapeutic and medical needs, and will not distribute the said medication(s) to others.
• I am requesting that a licensed prescriber act only in an adjunct capacity to my local physician, not replace my local physician, when reviewing my request, and if authorizing the prescription drug(s) for dispensing by the virtual clinic's associated pharmacy.
• I am seeking the prescription(s) for the necessary supply of medication, not to stockpile beyond an already-adequate supply on hand.
• I will promptly contact a local physician for any necessary medical intervention should a complication or concern related to the use of the requested medication arise.
• I am allowed by law to use the credit card that will be used if my request is approved and processed.
• I have and will answer all questions truthfully, for my safety, just as I would in my local physician's office and care.
• I realize there are risks, as well as benefits, to any medication, even OTC drugs, and having been informed of possible effects, I consent to treatment as I may request and take full and complete responsibility.

I understand that Online Pharmacy is not a pharmacy, but an online escrow service that contracts with reputable, fully-licensed pharmacies that dispense medications to customers placing orders through its online escrow service system, and that acts as a medication broker between myself (the buyer) and the licensed pharmacy (the seller).

As part of our service and subject to the terms of this agreement we agree to provide you with information and other services that we may decide to offer. Upon notice published through the service, we may modify this agreement at any time. You agree and continue to agree to use our services in a manner consistent with all applicable laws and regulations and in accordance with the terms and conditions set out in the policies and guidelines outlined below. Please note that you will be referred to as 'the Customer' in this agreement.

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