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Patient Declaration
By agreeing to visit the site www.weightlock.com,
you are affirming to the following:
- I have understood that www.Weightlock.com is an independent online advertising medium and has no ability to operate as a pharmacy and hence, have no ability to take orders for prescription drugs and processing of orders. Hence, it is my sole responsibility to determine the accuracy and authenticity of the Pharmacy while placing an order with the pharmacy. I agree that by opting to purchase the medication, I am solely responsible for my decision.
- I have read, understand and agree to the “Terms
and Conditions” and “Disclaimer”
published on website. Further, I agree to use the website
in accordance with the stated conditions. I agree to use
the website for only personal and non-commercial purposes.
- I am a competent adult at least 18yrs of age.
- I am permitted by law in my locale to receive the medication(s)
I am requesting for my personal medical and therapeutic
purposes. Further, I indemnify www.weightlock.com for
any loss, claim, damage or lawsuits resulting from any
medication used.
- I, the patient, have had a recent satisfactory and
sufficient physical examination and medical history evaluation
by a local physician who is available and whom I agree
to contact for any necessary local follow-up care and
intervention, in case I have any difficulties, possible
complications, or questions. I know also that I may contact
the prescribing physician and the dispensing pharmacy,
and I will keep those telephone numbers available.
- I have been fully informed by appropriately trained
health care personnel and understand the risks, benefits,
and possible side effects of the prescription medication(s)
I may request. I have studied written or internet materials
on these drugs including the websites and links that offer
in-depth material.
- I also affirm that I have previously safely used the
medication(s) I may request, under a physician's supervision,
or I have been advised by my examining physician that
the use of the medication(s) is not contraindicated for
me and is appropriate for my personal therapeutic and
medical needs.
- I am requesting the prescription medication(s) solely
for my own personal therapeutic and medical needs, and
will not distribute any of the medication to others.
- I am requesting that a licensed prescriber act only
in an adjunct capacity to my local physician, and not
replace my local physician, when reviewing my request.
I further request the prescriber to authorize the prescription
medication(s) for dispensing by the e-clinic's associated
licensed pharmacy.
- I affirm that I am seeking the prescription(s) for
a necessary supply of medication, not to stockpile medication
beyond an already adequate supply on hand.
- I will promptly contact my local physician for any
necessary medical intervention should a complication or
concern result related to the use of a requested medication.
- I agree not to take any over-the-counter medicines
without approval from my pharmacist who is informed of
my use of this and all medications.
- I am allowed by law to use the credit card that will
be used if my request is approved and processed. Further,
I agree to pay all the charges involved and represent
that the credit card company will honor my bills.
- I realize there are risks as well as benefits to any
medication, even over-the-counter medicines. I have been
fully informed of the effects, risks, and benefits of
this medication. I agree that I have been previously and
recently examined sufficiently as to physical and medical
condition, and I have been provided sufficient information
and adequately understand, the same as or more than, if
this consultation had taken place with my local physician
in a physical office setting.
- I fully agree that as a customer it is my sole responsibility
to abide by the rules, taxes, and tariffs applicable in
the country I reside.
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