TERMS
AND CONDITIONS
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MAY EXPRESS CERTAIN OPINIONS OR PROVIDE CERTAIN INFORMATION
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TO THE COMPLETENESS, ACCURACY, TIMELINESS, OR RELIABILITY
OF INFORMATION OR OFFERS SUPPLIED BY THIRD PARTIES AND
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PARTY, INCLUDING ANY SUCH THIRD PARTY'S CONFORMANCE
TO ANY LAW, RULE, REGULATION OR POLICY.
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SERVICES, AND PRODUCTS CONTAINED IN THIS WEB SITE WILL
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AS PARTIAL CONSIDERATION FOR YOUR ACCESS TO OUR WEB
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IS NOT LIABLE TO YOU IN ANY MANNER WHATSOEVER FOR DECISIONS
YOU MAY MAKE OR YOUR ACTIONS OR NONACTIONS IN RELIANCE
UPON THE CONTENT. YOU ALSO AGREE THAT THE AGGREGATE
LIABILITY OF Completepills.com ARISING FROM OR RELATED
TO YOUR USE AND ACCESS, REGARDLESS OF THE FORM OF ACTION
OR CLAIM (FOR EXAMPLE, CONTRACT, WARRANTY, TORT, NEGLIGENCE,
STRICT LIABILITY, PROFESSIONAL MALPRACTICE, FRAUD, OR
OTHER BASES FOR CLAIMS), IS LIMITED TO THE PURCHASE
PRICE OF ANY ITEMS YOU PURCHASED FROM Completepills.com
IN THE APPLICABLE TRANSACTION. Completepills.com SHALL
NOT IN ANY CASE BE LIABLE FOR ANY DIRECT, INDIRECT,
SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES
EVEN IF Completepills.com HAS BEEN ADVISED OF THE POSSIBILITY
OF SUCH DAMAGES. THIS IS A COMPREHENSIVE LIMITATION
OF LIABILITY THAT APPLIES TO ALL LOSSES AND DAMAGES
OF ANY KIND. IF YOU ARE DISSATISFIED WITH OUR WEB SITE
OR ITS CONTENT (INCLUDING TERMS OF USE), YOUR SOLE AND
EXCLUSIVE REMEDY IS TO DISCONTINUE USING OUR WEB SITE.
BECAUSE SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION
OR LIMITATION OF LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL
DAMAGES, SUCH LIMITATION MAY NOT BE APPLICABLE TO YOU.
This Agreement shall be governed by and construed
in accordance with the laws of the State of Delaware,
without regard to choice of law rules. Any litigation
arising out of or in connection with the use of this
web site shall be exclusively in state or federal courts
located in Kent County, Delaware.
If any part of this Agreement is ruled to be unenforceable,
then such part shall be eliminated or limited to the
minimum extent necessary. The remainder of the Agreement,
including any revised portion, shall remain and be in
full force and effect. These terms of use are the entire
agreement between us governing your use of our web site.
Patient Responsibility and Waiver and Consent
By submitting this consultation form, I affirm as if
under oath and state truthfully that:
I am a competent adult at least 18 years 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.
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 affirm that I have answered and will answer all questions
truthfully, for my safety, just as I would in my local
physician's office and under that physician's care.
I have fully and completely disclosed any and all information
concerning my health and medical history that may possibly
be relevant to my request for this medication.
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 U.S. 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 agree to monitor my blood pressure at least once
every 10 days. If my blood pressure is over 140/90 (either
the top number is greater than 140 or the bottom number
is greater than 90), I agree to stop taking this medication
immediately and will contact my local physician.
I am allowed by law to use the credit card that will
be used if my request is approved and processed.
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 understand, accept, and agree to each of the following
statements:
I understand that use of this website is completely
voluntary and initiated by me. I attest that I am accessing
this site because I am seeking treatment for an identifiable
medical or cosmetic condition. I understand that all
prescription medications purchased cannot be returned
or refunded.
I am aware that the physician reviewing my Medical
History questionnaire will not have the opportunity
to conduct an in-person physical examination (referred
to as the "Prescribing Physician" throughout
the remainder of this Agreement). I attest that I have
undergone a comprehensive, in-person physician-conducted
physical examination by my primary care provider within
the last twelve months and will provide my Prescribing
Physician with a copy of my medical records related
to this examination upon request. Furthermore, I will
report the results of this examination along with any
other significant aspects of my past or present health
history or current health status including a list of
all prescription and over-the-counter medication I take
once a week or more often on the Medical History questionnaire
I submitted to this website. I also acknowledge that
there is a blank field at the body of the Medical History
questionnaire that allows me to note any additional
information about me that the Prescribing Physician
should know. I understand that the Prescribing Physician
will determine whether it is medically appropriate for
me to receive the medication I have requested based
on the information I provide in the Medical History
questionnaire, and, therefore, I have an absolute obligation
to answer that Medical History questionnaire completely
and in a truthful manner for my safety. I agree to provide
the Prescribing Physician with any additional information
he or she requests beyond that which I supplied as part
of my Medical History questionnaire. I also understand
that if I fail to answer the Medical History questionnaire
honestly, accurately, and completely, my inaccurate
answers could cause the Prescribing Physician to unknowingly
make an inappropriate treatment decision that could
affect my physical or mental health.
I understand that my Medical History questionnaire
will be reviewed by a Prescribing Physician who is located
and is licensed to practice medicine in the United States.
I am aware, however, that the Prescribing Physician
reviewing my Medical History questionnaire and prescribing
any medication may NOT be located or licensed to practice
medicine in the state where I am located at the time
I submit my Medical History questionnaire to this website.
I agree that all medical decisions made by the Prescribing
Physician regarding whether any drug treatment is medically
appropriate for me will be deemed to have occurred in
the state where the physician is physically located,
and not the state where I am located, should they be
different. I attest I am under the care of a primary
care physician and I do not consider the Prescribing
Physician to be my primary care physician. I will not
rely on or substitute the advice given by the Prescribing
Physician should it contradict with the advice given
to me by my primary care physician.
In the event the Prescribing Physician determines the
medication I requested is medically appropriate for
me, I agree to notify my primary care physician that
I intend to begin taking such medication. I recognize
it is my responsibility to seek regular physical examinations,
including any suggested laboratory tests, to ensure
that I do not have a condition which will make my taking
any medication prescribed by the Prescribing Physician
inappropriate or dangerous. I am aware that there exists
potential side effects associated with taking any medication.
By requesting this on-line evaluation, I personally
accept all risks involved in taking any medication that
may be prescribed by the Prescribing Physician and I
will not seek any indemnification, any damages of any
kind, or any other liability from Completepills.com,
its parent company, subsidiaries, affiliates, contractors,
or partners, or the Prescribing Physicians if I experience
any of the side effects. I understand that neither Completepills.com
nor the Prescribing Physician makes any guarantee that
the prescription medicines I am requesting will provide
the results I seek.
I hereby release Completepills.com from any and all
claims related to allegations that the Prescribing Physician
acted unprofessionally or below the standard of reasonable
medical care solely because he/she did not perform an
in-person physical examination on me. I understand that,
for purposes of determining whether it is medically
appropriate for me to receive the requested medication(s),
the Prescribing Physician will form his or her medical
opinion based on review of the information I provide
in my Medical History questionnaire.
I acknowledge that this website does not practice medicine.
I understand that Completepills.com only offers an on-line
forum that allows me to request a physician evaluation
regarding a particular health condition based on the
information I provide on my Medical Health questionnaire.
I further understand that this website provides certain
management and administrative services to the Prescribing
Physicians such as, but not limited to, storage and
maintenance of medical records, marketing services,
and contracting with the web site hosting company.
I understand that the Prescribing Physicians are not
employees of CompletePills.com, rather they are independent
contractors to whom CompletePills.com forwards my information
for review and response. Neither CompletePills.com, nor any
of its affiliates, directs, controls or influences the
treatment decisions made by the Prescribing Physician
with respect to my care and/or my request for certain
medication(s). Accordingly, I agree not to hold CompletePills.com
liable for any negligent act or omission of the Prescribing
Physician;
I understand that my medical record is the property
of the Prescribing Physician, but is stored and maintained
by CompletePills.com pursuant their written privacy policy
which I have reviewed. I understand that because CompletePills.com
forwards the information I submit to this website to
a Prescribing Physician, it has access to all my personal
information including my health information, and has
a right to retain and use any and all portions of my
medical record in accordance with the CompletePills.com Privacy
Policy posted on this website. I understand that I have
a right to access the personal information CompletePills.com
has collected about me through this website and correct
any inaccuracies. I also understand that I may request
a written copy of my medical record and that I will
be charged a reasonable administrative fee for copying
and mailing such records.
In accordance with the United States Arbitration Act,
I agree that any dispute arising out of or related to
the provision of services by Completepills.com, its
affiliates, or their respective employees, partners
and agents, as well as any dispute arising out of or
related to the provision of services by the Prescribing
Physician shall be subject to final and binding arbitration
exclusively through the procedures of the American Arbitration
Association. I agree that any arbitration, administrative
proceeding, or other dispute resolution proceeding in
which Completepills.com, is a party pertaining in any
way to this site will be held in the County of Kent,
State of Delaware, and in no other forum in any other
place. This Consent and Waiver expressly includes knowing
consent to transfer the venue of any dispute of any
kind to the above county and state for resolution. Likewise,
I agree that any dispute with the Prescribing Physician
and which does not involve Completepills.com, that involves
arbitration, an administrative proceeding, or other
dispute resolution proceeding shall be held in the county
in which the Prescribing Physician has his/her primary
place of business.
This document also serves as my informed consent to
allow Completepills.com access to any of my medical
information, including all medical data contained in
the "Medical History" questionnaire including,
but not limited to, any health information regarding
HIV, mental health, alcohol, drug or substance abuse
conditions or treatments ("Medical Information").
I hereby authorize my primary care physician to release
or disclose to my Prescribing Physician any and all
Medical Information that the Prescribing Physician deems
necessary to form his/her medical opinion. I can revoke
this authorization at any time by providing written
notices to the website. I understand that a revocation
of authorization for my primary care physician to disclose
my Medical Information will not apply to Medical Information
already in the possession of Completepills.com or the
Prescribing Physician.
ALL INFORMATION , PRODUCTS, AND SERVICES PROVIDED ON
THIS WEBSITE ARE PROVIDED "AS IS" WITHOUT
ANY WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. BY MY
USE OF THIS WEB SITE, I ACKNOWLEDGE THAT SUCH USE IS
AT MY SOLE RISK. I ALSO AGREE THAT THE AGGREGATE LIABILITY
OF Completepills.com ARISING FROM OR RELATED TO MY USE
AND ACCESS, REGARDLESS OF THE FORM OF ACTION OR CLAIM
(FOR EXAMPLE, CONTRACT, WARRANTY, TORT, NEGLIGENCE,
STRICT LIABILITY, PROFESSIONAL MALPRACTICE, FRAUD, OR
OTHER BASES FOR CLAIMS), IS LIMITED TO THE PURCHASE
PRICE OF ANY ITEMS YOU PURCHASED FROM Completepills.com
IN THE APPLICABLE TRANSACTION. Completepills.com SHALL
NOT IN ANY CASE BE LIABLE FOR ANY DIRECT, INDIRECT,
SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES
EVEN IF Completepills.com HAS BEEN ADVISED OF THE POSSIBILITY
OF SUCH DAMAGES. THIS IS A COMPREHENSIVE LIMITATION
OF LIABILITY THAT APPLIES TO ALL LOSSES AND DAMAGES
OF ANY KIND. IF YOU ARE DISSATISFIED WITH OUR WEB SITE
OR ITS CONTENT (INCLUDING TERMS OF USE), YOUR SOLE AND
EXCLUSIVE REMEDY IS TO DISCONTINUE USING OUR WEB SITE.
I UNDERSTAND AND AGREE THE Completepills.com IS NOT
RESPONSIBLE FOR THE INTENTIONAL OR NEGLIGENT ACTS OR
OMISSIONS OF ANY HEALTH CARE PROVIDER, SUCH AS THE PRESCRIBING
PHYSICIAN OR PHARMACY, TO WHICH Completepills.com MAY
CONNECT ME. |