ACKNOWLEDGEMENT AND CONSENT BY CUSTOMER
As a material inducement for the services to be rendered by BUYFIORICETMEDICATION.com Website (this "website"). I do hereby acknowledge and agree that:
I am above the age of eighteen (21) years. I am competent to use the services offered by this website and affiliated pharmacy, and I fully understand the material contained on this website and use it of my own free will, and that I did not act under duress or undue influence.
I understand that I am seeking a medical consultation with a licensed healthcare provider, and understand fully the importance of the medical questionnaire that I will be/have been required to fill in, and that the healthcare provider will not have the opportunity to physically examine me, and will rely fully on the said medical questionnaire and/or video call.
I understand and confirm that the medical questionnaire contains my full and honest medical history, and that I have answered the questions truthfully, openly and honestly, and to the best of my knowledge.
I understand that this website is owned and operated by a third party company that refers me (the customer) to a Pharmacy.
I acknowledge that this website does not practice medicine. I further acknowledge that this website or it's owner(s) cannot and do not direct, control or influence the medical opinions or decisions made by the Physician or clinician with respect to my care.
I acknowledge that I have been given the opportunity to ask any and all questions about the medication(s) I have been prescribed. I understand that the healthcare provider is independent, is not an employee or principal of this website, and also is not my personal physician.
If prescribed, medications are issued solely at the discretion of the licensed healthcare provider and may be fulfilled by a licensed pharmacy, which may be located in a different state in accordance with applicable laws. Pharmacies are independent entities responsible for dispensing medications.
I acknowledge that a healthcare provider may, upon examining my medical questionnaire, prescribe medication. I acknowledge that a healthcare provider may, upon examining my medical questionnaire, decline to issue a prescription for medication or deem it appropriate to conduct a video/telephone consultation with me. The healthcare provider/pharmacy may, with or without conducting a telephone consultation with me, accept or decline the prescription issued to me for medication.
I understand that there are risks as well as benefits in taking any medication. If prescribed a medication, the medication is solely for my own medical needs, and I will not distribute, sell, or otherwise dispense the medication(s) to any other persons. I am not requesting the medication(s) from multiple sources in order to provide or add to a stock of such medication or to exceed the amount necessary for my current personal medical needs.
I have undergone a physical examination by a physician licensed to practice medicine in my state (herein after called the 'Primary Physician') and that the Primary Physician has diagnosed a certain medical condition which I shall specifically disclose on my medical questionnaire. Therefore I am utilising the services of this website to obtain medication for the identified medical condition and not for a medical condition which has not previously been diagnosed as a result of a physical examination by a physician licensed to practice medicine in my state.
I confirm that I will use the medication prescribed by the healthcare provider only after consultation with my Primary Physician and that should the Primary Physician recommend that I discontinue the treatment, or alter it, or in any way supplement or reduce it, my Primary Physician's advice regarding the prescribed medication shall take precedence over that of the Prescribing Physician.
I accept that the prescribing medical consultation and the telemed consultation shall be deemed to have been carried out in the healthcare provider's state of residence and professional practice.
I understand that Telehealth services are provided in accordance with applicable state and federal laws and regulations.
I hereby accept again that the healthcare provider shall rely upon my medical questionnaire and my tele-visit consultation should it have been performed. I confirm, regarding my medical questionnaire that:
I have answered all questions truthfully and honestly and to the best of my knowledge.
I have undergone a full physical examination by my Primary Physician in order to be able to fully and honestly complete the medical questionnaire. Therefore, I hereby agree to indemnify and hold harmless this website, it's Owner(s), Affiliates, the healthcare provider(s) and any pharmacy and/or pharmacist who may hereafter dispense the prescription (Dispensing Pharmacy) against any and all liability arising from any condition that I might suffer following medication prescribed by the healthcare provider based upon his/her reliance on my medical questionnaire.
I further warrant that I have checked to ensure that ordering prescription drugs into my state of residence does not violate the laws of my state or any state at which I may accept delivery of medication prescribed for me by this service.
I acknowledge and accept that this is a third party website that refers me to a pharmacy and this website is not practising medicine in any capacity, but is simply acting as a medium to refer a specific request for treatment to a specific physician.
I understand that my personal and medical information will be collected, used, and stored in accordance with applicable privacy laws and used for purposes of treatment, payment, and healthcare operations.
I understand in the event of any dispute, claim, or controversy arising out of or relating to the use of this website or services: The parties agree to first attempt to resolve the dispute through good-faith mediation in the State of Florida. If the dispute is not resolved within thirty (30) days, it shall be resolved by binding arbitration administered by the American Arbitration Association in accordance with its applicable rules. All disputes shall be resolved by binding arbitration administered in the State of Florida. Arbitration may be conducted in person or remotely by video conference, as mutually agreed or determined by the arbitrator. The arbitration decision shall be final and binding, and judgment may be entered in any court of competent jurisdiction. This agreement shall be governed by the laws of the State of Florida, without regard to conflict of law principles
I shall seek information from my Pharmacist and/or Primary Physician regarding the risks, benefits, and possible side effects of any medication prescribed by this service.
I will use such medication under the strict supervision of my Primary Physician, whose advice shall take precedence over that of, and shall not be supplanted by that of, the healthcare provider.
I undertake to make contact promptly with my Primary Physician or any medical practitioner for any necessary emergency intervention should a complication arise following my use of the prescribed medication.
I appreciate that there are always attendant risks to the use of any medication. I hereby indemnify this website, it's Owner(s), Affiliates, the healthcare providers and dispensing pharmacy from liability if any severe or other side effects should result from my use of the prescribed medication. I personally accept all risks involved in taking the prescribed medication.
I appreciate that no health professional may guarantee that the medication prescribed shall have the desired effects or will provide the results I seek. Further regarding my use of this website , I have used and shall always use these facilities for the purpose only of seeking medical treatment, not for stockpiling drugs to an already adequate supply.
I understand and agree that this website or the owner(s) affiliated with this website shall not be liable for any acts or omissions of the healthcare providers, Telemed Physicians, the Dispensing Pharmacy and of my Primary Physician in advising me or communicating with me with regard to the prescribed medication. The liability if any, of this website shall extend only up to such amount as may represent the purchase price of any medication and products concerned in any relevant transaction.
I agree to release this website, it's owner(s), its employees, agents, principals, corporate affiliates and all related parties from any liability arising from my consumption of prescribed medications and for medical, physical or behavioural and other effects of any medication that I may take as a result of my seeking a consultation via the Internet. I hereby release this website and it's owner(s) and clinician from any and all claims that the physician acted below the requisite standard of care on the basis that the Physician did not personally examine me.
If any provision of this agreement is held to be illegal, void or unenforceable, then this agreement may be modified or amended only to the extent necessary to enable the remaining provisions to be of force and effect to the maximum degree.
I acknowledge that, by submitting an order, I confirm that I have read, understood, and agree to this Acknowledgement and Consent.