|
By placing my order with phoneconsultation, I accept and understand the following:
1. I give my permission for phoneconsultation and our medical partners to perform and undertake an on-line medical consultation and evaluation of me as a potential patient. I Must Have A Physical Exam Before Using phoneconsultation
2. By submitting a questionnaire for review for a consultation and possible prescription(s), I agree to release from liability and hold harmless phoneconsultation, their affiliates, subsidiaries, directors, officers, employees, representatives, and independent contractors from all causes of action, suits, penalties, liens, judgments, liabilities, obligations, losses, actual or consequential damages, actual or threatened claims which may arise at any time by reason of, relating to, arising directly or indirectly out of any matter whatsoever related to the prescription of my selected medication.
3. This consultation is being submitted by my own choice, at my own expense, and my own liability and I assume all responsibility for my use of treatments prescribed by phoneconsultation. I fully understand that it is my responsibility to have an annual physical examination, including any suggested laboratory tests, to ensure that I have no disease that might be incompatible for my self-described condition. I further agree to immediately notify any doctor whose present care I am under that I have chosen to take a prescription prescribed by phoneconsultation so that they may advise to continue or discontinue use and. Should I engage a new doctor's care in the future, I further agree to immediately notify said doctor of my use of treatments prescribed by phoneconsultation. I also agree whilst taking a prescription from phoneconsultation, I have no other providers or prescriptions currently active.
4. I accept and understand that treatments prescribed by phoneconsultation may have side effects that may be defined by the doctor during my consultation and will additionally be included with my prescription. The possible side effects and complications are being provided based solely upon the information given to phoneconsultation by me both verbally and included in the written questionnaire provided to phoneconsultation.
5. I hereby release phoneconsultation and all of their employees and contractors including physicians and pharmacists from any and all liability whatsoever associated or connected with my consultation/or my use of treatments prescribed as Governed in the State in which the physician is licensed and resides. I hereby state that I am an adult as defined in the state of which I reside. I understand that falsifying information in order to obtain prescription medication is a violation of both State and Federal US law. I hereby agree to answer truthfully all of the medical questions on my questionnaire.
6. I understand that no doctor, nurse, or administrative personnel can guarantee that beneficial treatments, even if prescribed, will provide the results I seek. Further, I understand that even if prescribed, I may suffer adverse effects from treatments. I hereby release phoneconsultation and all of its employees and contractors including physicians and pharmacists from any and all liability whatsoever associated with any adverse effects I may suffer from my use of prescribed treatments as governed in the State in which the physician is licensed and resides. I understand that it is my responsibility to furnish phoneconsultation with my complete and accurate medical history and follow up thereafter with any changes to it which occur at a subsequent time.
7. I understand that the proposed consultation and care may involve risks and possibilities of complications and that certain complications or side effects have been known to occur in patients who take prescribed treatments even when the utmost care, judgment, and skill are used. I acknowledge that no guarantees have been made to me as to the results or are there any guarantees against favorable results, risks, or complications.
8. I understand and acknowledge that there is no implied warranty to me and that treatments may benefit one patient and not another. I understand that there is no known medical treatment that gives 100% satisfaction to everyone.
9. I accept the risk of substantial and serious harm and/or complications from taking treatments prescribed by phoneconsultation and their medical partners. I acknowledge that I understand the risks. Any and all questions that I have about treatments prescribed by phoneconsultation and its attendant risks have been answered to my satisfaction.
10. I understand and agree that phoneconsultation and its employees may see any information I provide to my physician and that such information will constitute a medical record. I further understand and agree that , my phoneconsultation physician, or both will maintain my medical record.
11. I understand and acknowledge that phoneconsultation and its physicians RECOMMEND A PHYSICAL EXAMINATION BY A DOCTOR BEFORE I TAKE TREATMENTS PRESCRIBED BY phoneconsultation. I understand that an on-line medical consultation will NOT include a physical examination. I HEREBY WAIVE A PHYSICAL EXAM at this time and AGREE to obtain a timely medical follow-up examination with a physician before I take treatments prescribed by phoneconsultation. I also ATTEST that the medical condition that I am self-describing is true and that the condition may be defined as an “Emergency Medical Situation.” An Emergency Medical Situation” may be defined as “a condition of emergency in which immediate medical care or hospitalization, or both, is required by a person or persons for the preservation of health.” This definition may be modified in meaning and or definition to constitute the definition of a “Temporary Doctor/Patient Relationship” in the state in which I reside and/or the doctor resides, is licensed and or practices medicine.
12. I acknowledge and agree that I initiated the contract with phoneconsultation and its physicians may be located in another state or country from my own and that the Physician may NOT be licensed to practice medicine in my state of residence.
13. I AGREE THAT ALL ON-LINE 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.
14. I fully understand and agree that if I fail in any way to furnish phoneconsultation with my complete and accurate medical history, or I become aware of any changes in my physical or medical condition in the future and I fail to notify phoneconsultation or its physicians of such changes, then I agree that I am solely responsible for any adverse effects I may suffer from taking or continuing to take treatments prescribed by or phoneconsultation from participating in this program.
15. Refunds will be given at the discretion of the company management.
16. I understand and agree that I am responsible for all customs, tariffs, and taxes, if applicable, in my state or country. “Please ensure that the medication is permitted in your country.”
17. I UNDERSTAND AND AGREE THAT I AM ACCEPTING OR REJECTING THE TERMS OF THIS "CONSENT TO MEDICAL CARE'' BY ELECTRONICALLY MAKING MY CHOICE BELOW. IF I SELECT " I have read and accept the Terms of Agreement'', I ACKNOWLEDGE THAT SUCH CHOICE WILL CONSTITUTE THE EQUIVALENT OF MY SIGNATURE UPON A BINDING AGREEMENT BETWEEN phoneconsultation AND MYSELF.
18. I have read and understood the above-referenced provisions and authorize and accept the proposed terms and care regardless of the medical or legal risks and I declare that I understand the risks.
19. If, after review of my questionnaire, a doctor determines that a prescribed treatment is the appropriate treatment for my condition, I hereby authorize a charge of $250.00 to be charged to my credit card as a consultation fee. I understand that this charge is in addition to the cost of any possible prescribed medication, and if so, I understand that I may automatically qualify for up to two additional months of refills without a processing or additional consultation fee. I also understand that I must initiate any refills by contacting phoneconsultation. I hereby authorize shipping and prescription charges to be charged to my credit card in accordance with the shipping information that I have supplied and any prescriptions that have been prescribed to me as a result of the doctors’ consultation.
If you are not granted a consultation and/or prescription and/or treatment by the doctor, you will get a refund. The doctor that reviews your consultation and determines that prescribed treatments are not appropriate for your condition. You must answer ALL Questions requested in the questionaires. If you feel a particular question does not apply, do not order
|