Patient Declaration
By agreeing to visit the site http://www.birthcpills.com, you are
affirming to the following:
- 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 http://www.birthcpills.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 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 take the responsibility to determine the accuracy and authenticity
of the online pharmacy while placing any orders. I agree that
by opting to purchase prescription medication through the pharmacy
listed on http://www.birthcpills.com, I am solely responsible
for my decision.
- I agree that the pharmacy listed in http://www.birthcpills.com
claims to be a licensed pharmacy eligible to dispense medicines
under the applicable local laws, rules and regulations and in
no way can http://www.birthcpills.com be held responsible for
any fault in the service.
- 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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