I hereby appoint www.Canadamednet.com, its affiliated physicians,
pharmacy and pharmacists as my agent and attorney for the
purposes of obtaining a prescription from a Medical Doctor
in Canada (the "Canada MD") which corresponds to
the prescription included in this order. The acts authorized
may include directly contacting my prescribing physician,
and purchasing and arranging delivery of the medications prescribed
in the Canadian prescription, substantially on the terms set
forth below, and all to the same extent that I could if I
personally took such steps. I hereby consent to and authorize
www.Canadamednet.com, the Canadian MD and affiliated Canadian
pharmacy to collect my personal medical information and to
maintain on file the information necessary to verify and process
future orders, including but not limited to my name, address,
phone number and payment information. I understand that my
personal information will be handled only by www.Canadamednet.com
and its affiliated Canadian pharmacy's processing employees
and contractors (including physicians and nurses, pharmacists
as posted on the www.Canadamednet.com's website, the Privacy
Policy may be updated from time to time.
DISCLOSURE AND REPRESENTATIONS
I represent that all of the following statements are true
and understand that www.Canadamednet.com, its affiliated Canadian
pharmacy, their employees and contractors (physicians and
nurses, pharmacists and pharmacy technicians) are relying
on the following representations:
I am at least of the age of majority or older according to
the laws of the state in which I reside and I can make my
own medical decisions.
The prescription that I am requesting www.Canadamednet.com
to assist me in obtaining was prescribed by a licensed United
States (U.S.) physician and has not been altered.
I will use any medication obtained for me by www.Canadamednet.com,
strictly in accordance with the instructions provided by the
physician who prescribed the medication(s).
I am placing this order for medication for my sole use and
I will not provide any of this medication to another person.
I have had a physical examination within the past twelve (12)
months, and my current physician either conducted that examination
or has reviewed the results of that physical examination.
I will immediately contact the physician who provided my prescription(s)
to be filled under this order in the event I suffer any unexpected
side effects from any medication(s) provided to me by www.Canadamednet.com's
affiliated Canadian pharmacy. www.Canadamednet.com has made
no representations or warranties regarding the use or fitness
for any particular purpose of the medication(s) delivered
(including, without limitation, its appropriateness for curing
or helping relieve any particular ailment, illness or disease,
or its potential or actual side or adverse effects whether
previously known or unknown).
PURCHASE AND SALE TERMS
I choose to pay for my order by credit card. www.Canadamednet.com
will charge my credit card the following amounts (in U.S.
the medication price,
and $12.00 for each package www.Canadamednet.com ships, and
any applicable taxes.
In the event my credit card company does not authorize my
payment, www.Canadamednet.com has the right to cancel my order
and attempt in good faith to promptly notify me of such cancellation.
Whenever possible, and unless otherwise instructed by the
prescribing U.S. physician or by me, www.Canadamednet.com's
affiliated Canadian pharmacy will substitute lower cost generic
drugs for any prescribed brand name prescription drugs.
www.Canadamednet.com is not providing its services as agent
or limited power of attorney as a substitute for health care
or the advice of a licensed physician.
www.Canadamednet.com will not exchange medication or return
any monies paid once an order is filled, unless the medication
provided to me by the supplying pharmacy does not correspond
with my prescription.
I understand that this agreement will cover the initial and
all subsequent purchases from www.Canadamednet.com.
This agreement, along with any disputes that may arise, will
be governed by and construed in accordance with the laws of
the Province of British Columbia, Canada.
I have read and understand all of the foregoing.