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I understand I must read and agree to the following acknowledgment
and release form before World Canadian Drugstore and it's Associated
Pharmacy will be able to fill any of my prescriptions.
World Canadian Drugstore and it's Associated Pharmacy , its
affiliates and related companies, shall be hereinafter collectively
referred to as WCD&AP.
I hereby confirm that I am 21 years of age or older, or the
parent or legal guardian of a patient if under the age of 21
years, and that I am fully competent to make my own health care
decisions. I am aware of the potential side effects associated
with prescription medications and understand that it would be
a violation of law to falsify any information on my questionnaire
or other medical record for the purposes of obtaining prescription
medication. I agree to truthfully and to the best of my knowledge
answer all the questions in my medical questionnaire. I agree
that if I fail in any way to fully furnish my complete and accurate
medical history of I become aware on any changes in my physical
or medical condition in the future and I fail to notify WCD&AP
of such failure, that I am solely responsible for any adverse
effects that I may suffer from taking or continue to take such
prescribed medications.
I confirm to WCD&AP that the pharmaceutical(s) to be delivered
to me were prescribed by a doctor licensed to practice medicine
in the country, state or other applicable jurisdiction in which
the undersigned resides, that the prescription(s) for the pharmaceuticals
were lawfully obtained from that physician and that the pharmaceutical(s)
will be used only as directed and only by the person for whom
the pharmaceutical was prescribed.
WCD&AP is required to have a licensed Canadian Physician
(the "Canadian Physician") review my medical information
for the purposes of independently verifying whether the medications
prescribed by My Own Physician are appropriate.
By Reviewing my medical information, the Canadian Physician
is not rendering or providing any service or advice to me whatsoever.
I understand that it is my responsibility to have My Own Physician
conduct regular physical examination of me, including any and
all suggested testing by My Own Physician to ensure that I have
no medical problems which would constitute a contradiction to
me taking medication prescribed for my by My Own Physician. I
agree that should I suffer adverse effects while taking any prescription
medications, that I will immediately contact My Own Physician
and that in the event I come under care of another physician,
I inform him or her of any and all medications that I have been
prescribed. I acknowledge and agree that WCD&AP recommend
regular physician examinations with My Own Physician whose care
I am under and who initially prescribed my medications.
I hereby give permission to my own physician to release any
and all medical information and data whatsoever which WCD&AP
shall request for the purposes of performing a medical review
to determine whether the medications prescribed by my own physician
are appropriate in the circumstances. I hereby give permission
to my own physician to release my medical files and medical reports
as needed to obtain sufficient information for the purpose of
such review.
I understand that any information provided to WCD&AP may
be seen by its employees, agents and contractors and that this
information will constitute a medical records. This information
will not be shared with any associates or third parties outside
of or not affiliated with WCD&AP.
I understand and agree that WCD&AP are located in the
country of Canada and that the Canadian Physicians and pharmacists
working for WCD&AP are located and licensed to practice medicine
and pharmacy, respectively in Canada only and any prescription
if any that I am receiving from such physicians and pharmacists
shall be deemed to be received by me in Canada.
I further understand that WCD&AP will only verify and
fill medications that my own physician has already prescribed
to me. I also understand that no controlled medications, narcotics,
tranquilizers or other medications that the Canadian Physician
decides is inappropriate, will be filled.
I hereby waive any requirement of the Canadian Physician under
the laws of Canada, the United States or any other country to
conduct a physical examination.
I understand and agree that the review of medical information
by a Canadian Physician is in no way intended as a means to diagnose
any medical condition and does not substitute the requirement
for me to obtain my own professional advice from my own physician.
I will consult My Own Physician before taking any drug or changing
my daily health regimen. I understand that any opinions, advice,
statements, services, offers or other information expressed or
made available by third parties (including merchants and licensors)
are those of the respected authors of distributors of such content.
I hereby waive my right to pharmacy counseling, as I have
previously been counseled.
I release World Canadian Drugstore and all associates and
directors, as well as all associated pharmacies and companies
from all liability and error, and understand that ordering from
World Canadian Drugstore.com and its Associated Pharmacy is done
so at my own risk.
I AGREE THAT WORLD CANADIAN DRUGSTORE, ALL ASSOCIATES, DIRECTORS,
ASSOCIATED COMPANIES AND PHARMACIES, AND THE CANADIAN PHYSICIAN
SHALL NOT BE LIABLE FOR ANY LIABILITY, CLAIM, LOSS, DAMAGE OR
EXPENSE OF ANY KIND OR NATURE CAUSED DIRECTLY OR INDIRECTLY BY
ANY INADEQUACY, DEFICIENCY OR UNSUITABILITY OF THE PRESCRIPTION
ISSUED BY THE CANADIAN PHYSICIAN OR THE INADEQUACY, DEFICIENCY
OR UNSUITABILITY OF THE CANADIAN PHYSICIAN'S REVIEW OF MY MEDICAL
INFORMATION. IN NO EVENT WILL WORLD CANADIAN DRUGSTORE, ALL ASSOCIATES,
DIRECTORS, ASSOCIATED COMPANIES AND PHARMACIES, AND THE CANADIAN
PHYSICIAN BE LIABLE OR RESPONSIBLE FOR ANY DAMAGES WHATSOEVER,
INCLUDING, DIRECT, INDIRECT, PUNITIVE, SPECIAL OR CONSEQUENTIAL
DAMAGES, EVEN IF ADVISED OF THE POSSIBILITY THEREOF.
By using this site you agree to the terms and agreements between
you and WCD&AP. This agreement also governs the use of our
website worldcanadiandrugstore.com and all of its contents. You
agree to be bound by this agreement each and every time you use
this website and accept all responsibility for all charges if
any associated with connecting to WCD&AP prescription service.
Return Policy: Due to the nature of the products, products
are not returnable, all sales are final. Sorry no refunds.
I understand that all prices will be charged to my credit
card in US dollars.
I HAVE READ AND UNDERSTAND THE ABOVE REFERENCED PATIENT
ACKNOWLEDGEMENT AND RELEASE FORM AND AGREE TO EACH OF THE FOREGOING
TERMS.
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