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I, the patient, hereby certify that I have read, understood and agree to the
following:
- I am visiting this website, BestQualityHealth.com, of my own accord.
- I certify that I am 21 years of age or older and that I have answered all
questions honestly and am able to make my own decisions based on my medical
condition(s)
- I realize there are possible risks and side effects to any medication, including
over-the counter medications, and I am informed of possible effects, I consent
to treatment.
- I agree to speak with the prescribing physician should he/she feel it is
necessary.
- I am permitted by law in my city and state to receive the medication prescribed
by the physician.
- Within the past year, I have had a physical examination and medical history
evaluation by my primary care physician, who is available for any necessary
follow-up care should it be necessary.
- I am fully informed and understand the risks, benefits, and possible side
effects of the prescription medications, which may be prescribed by a physician.
- I have safely taken the medication(s) I may request under a physician's
supervision or been advised by an examining physician that the use of the
medication(s) is not contraindicated for me and is appropriate for my
therapeutic and medical needs.
- I am requesting the prescription medication(s) solely for my therapeutic and
medical needs.
- I will not distribute, stockpile, or share prescribed medication(s) with others.
- I am requesting that a licensed physician act only in an adjunct capacity to my
primary care physician, not replace my primary physician, when reviewing my
request and if authorizing the prescription drug.
- I will promptly contact my primary care physician or local emergency room for
any necessary medical complications or concerns resulting from the use of a
prescribed medication.
- I acknowledge that I will be using a pharmacy through Best Quality Health and
waiving my right to select my own pharmacy.
- The credit card I am using belongs to me or I have the permission of the credit
card holder.
- I will answer all questions asked on the Medical Health Profile, by the
physician and/or medical personnel honestly and to the best of my knowledge.
- I will immediately inform my primary care physician of any new treatment I
receive.
- I understand that if I cannot be contacted or cannot provide the proper
identification or required records, all monies will be forfeited 45 days after
requesting medication
- I have not ordered or received this medication from anywhere in the past 27
days. If you have ordered or received this medication from anywhere in the
past 27 days your order will not processed.
Release and Consent to Treatment Agreement.
- I, the patient, hereby release Best Quality Health, all of its employees and
contractors including physicians and pharmacies from any and all liability
associated with or connected to the medication prescribed and/or consultation.
- I hereby state that I am an adult (21 or older) and that I am aware of the
potential side effects associated with the medication prescribed.
- I agree to answer truthfully and to the best of my knowledge all medical
questions on my Medical Health Profile.
- I understand that no doctor, nurse, or administrative personnel can guarantee
that any medication, even if prescribed, will provide the results I seek.
Further, I understand that even if prescribed, I may suffer adverse effects from
medications. I hereby release Best Quality Health and all of its employees and
contractors including physicians and pharmacies from any and all liability
whatsoever associated with any adverse effects I may suffer from my use of
medications prescribed.
- I, the patient, initiated the contact with Best Quality Health and
understand that its physicians my be located in a different state than the one
in which I reside, and that the physician may not be licensed to practice
medicine in my state of residence. I agree that all online, telephonic and/or
video medical consultations, diagnoses, and treatments will be deemed to have
occurred in the state where the physician is physically located and licensed to
practice medicine.
- It is my responsibility to use medications only as prescribed.
- I fully understand that it is my responsibility to have a physical examination,
including any suggested laboratory tests, to ensure that I have no disease(s)
that might make prescribed medications inappropriate for my condition.
- I agree to contact my primary care physician and/or pharmacist prior to taking
any over-the-counter or newly prescribed medication.
- I further agree that I have consulted with my physician and/or pharmacist and
hereby warrant that I am not taking any medications or combination of
medications that are on the published list of medications that are
contraindicated with my prescribed medication.
- I further agree to immediately notify my primary care physician or any doctor
whose present care I am under that I have chosen to take prescribed medication
so that they may advise to continue or discontinue use.
Best Quality Health is unable to accept returns or issue refunds for any orders
due to the fact that this is a prescription medication.
The laws will not allow ANY returns to the pharmacy under any circumstances.
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