Patient Declaration

• 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 www.activedietpills.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 www.activedietpills.com, I am solely responsible for my decision.
  
  
• I agree that the pharmacy listed in www.activedietpills.com claims to be a licensed pharmacy eligible to dispense medicines under the applicable local laws, rules and regulations and in no way can www.activedietpills.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.

Patient Declaration | Pharmacy Responsibility | Tips For Consumers | Terms & Conditions