I hereby appoint, 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, 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 and its affiliated Canadian pharmacy's processing employees and contractors (including physicians and nurses, pharmacists and pharmacy technicians) according to the Privacy Policy as posted on the's website, the Privacy Policy may be updated from time to time.

I represent that all of the following statements are true and understand that, 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 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, 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's affiliated Canadian pharmacy. 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).


I choose to pay for my order by credit card. will charge my credit card the following amounts (in U.S. dollars):

the medication price, and $12.00 for each package ships, and any applicable taxes.

In the event my credit card company does not authorize my payment, 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,'s affiliated Canadian pharmacy will substitute lower cost generic drugs for any prescribed brand name prescription drugs. 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. 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


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.

Web site design and development by Graphically Speaking

  Drug Search:

Tell a Friend