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PATIENT RESPONSIBILITY
STATEMENT AND INFORMED CONSENT
You should carefully read the following
disclaimer and consent form before
you proceed with your order as
placing an order is acceptance
of them.
I accept, understand and agree to
the following:
The information contained on this
site is general in nature and is
not meant to substitute for the
advice provided by your own physician
or other healthcare professional.
We do not warrant and shall have
no liability for information provided
in this site. This information is
provided solely for educational
and informational purposes including
as a potential guideline to be used
when discussing a program with a
healthcare professional. We are
not healthcare professionals and,
therefore, no information, advice
or direction that we give you either
on this site or by referring you
to the supplier should be taken
as medical or health advice, or
even as an indication in our opinion
that you are suitable to use Curaderm.
ALWAYS seek the advice of a healthcare
professional before taking any medication
and do not consider our acceptance
of your order or approval to place
an order as an indication or warrant
from us that you should use Curaderm
or any medication or as medical
or health advice in any form. ALWAYS
CONSULT A DOCTOR BEFORE USING ANY
MEDICINES.
Statement of Patient Responsibility
1. I am A COMPETENT ADULT at least
21 years of age,
2. I am permitted by law in my locale
to receive the medication(s) I am
requesting FOR MY PERSONAL MEDICAL
AND THERAPEUTIC PURPOSES,
3. I, the customer, 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,
4. I have been fully informed BY
APPROPRIATELY TRAINED HEALTH CARE
PERSONNEL and understand the risks,
benefits, and possible side effects
of the drug(s) I may request, I
HAVE STUDIED WRITTEN OR INTERNET
MATERIALS ON THESE DRUGS INCLUDING
THE WEBSITES AND LINKS THAT OFFER
IN-DEPTH MATERIAL,
5. 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,
6. I am requesting the medication(s)
solely for my OWN PERSONAL therapeutic
and medical needs, and will not
distribute any OF THE medication
to others,
7. I fully understand that RxGenesis
/ Curaderm, its employees and associates
are NOT U.S. or international licensed
prescribers, physicians or healthcare
professionals and that they are
not giving me any medical or pharmacological
advice that I should follow. RxGenesis
/ Curaderm DO NOT in any way condone
or recommend that you take any medicine
other than what your doctor or pharmacist
recommends. I also understand that
the information on this web site
and the referral that Curaderm makes
is not medical or pharmacological
advice and should NEVER replace,
compliment or substitute for the
advice given by my local physician.
8. I AFFIRM THAT I am seeking these
products for a necessary supply
of medication, not to stockpile
beyond an already adequate supply
on hand,
9. I will promptly contact a local
physician for any necessary medical
intervention should a complication
or concern result related to the
use of a requested medication,
10. I am allowed by law to use the
credit card that will be used if
my request is approved and processed
and realize there are NO RETURNS
allowed,
11. I FULLY UNDERSTAND AND agree
that the credit card will be charged
if Curaderm authorizes the requested
referral
12. I FULLY UNDERSTAND AND agree,
upon approval, I am receiving at
least the standard level of care
from a QUALIFIED PHYSICIAN,
13. 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 REFERRAL WHICH WILL RESULT
IN ME BEING DIRECTED TO AN INTERNET
SITE (not owned or endorsed by RxGeneis
or Curaderm or any of its employees
or associates) WHERE I MAY PLACE
AN ORDER FOR THE MEDICATION,
14. I realize there are risks as
well as benefits to any medication,
even Over The Counter drugs. I HAVE
been FULLY informed of THE possible
effects, RISKS, AND BENEFITS OF
THIS MEDICATION BY MY OWN QUALIFIED
PHYSICIAN. 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 CONSULTATION
TAKEN PLACE WITH MY LOCAL PHYSICIAN
IN A PHYSICAL OFFICE SETTING.
Please Read the Consent to Medical
Care Note:
I
hereby certify that I am over the
age of 21, am acting of my own volition
and am fully aware of the risks
and possible consequences of consuming
the prescription medication that
I may ultimately purchase. I certify
that I am not taking any medications
that are contraindicated with use
of the medication. I hereby release
RxGenesis / Curaderm, its officers,
directors, and executive management
personnel, administrators, employees,
contractor, referrers, successors
and assigns, (the 'Released Parties')
from all actions, causes of actions,
suits, sums of money, contracts,
controversies, agreements, promises,
damages, judgments, executions,
claims and demands whatsoever, in
law or in equity, which I ever had,
now have, or hereafter can, shall
or may have against the Released
Parties by reason of my purchasing
the prescription medication from
the web site that I may be referred
to, and consuming same, with full
acknowledgment that I may be releasing
claims of which I have no knowledge.
I represent and warrant that (1)
all the information I provide in
connection with my purchase from
RxGenesis / Curaderm and the web
site to which I will be directed
for purchase is true and correct;
(2) I am not taking any medication
which is contraindicated with use
of the un-prescribed medication
; (3) I do not have any health condition
which would increase my risk of
suffering an adverse reaction from
taking the UN-prescribed medication;
(4) I understand the Waiver and
Release terms above; (5) I will
undergo an examination by a physician
prior to taking the un prescribed
medication; and (6) I am fluent
in English and understand everything
I am agreeing to, including the
complete waiver of any claims I
may have against the Released Parties
for any reason whatsoever. I also
agree (1) to take appropriate and
necessary precautions to minimize
the risk of an adverse reaction
to the UN-prescribed medication;
(2) to seek immediate medical attention
in case of such adverse reaction;
(3) to immediately stop taking the
UN-prescribed medication following
an adverse reaction; and (4) I accept
these risks and assume the responsibility
for my own actions in ordering the
medication without a valid prescription
over the Internet, without the benefit
of a personal, face to face physical
examination by a physician. I also
understand that the Released Parties
strongly recommend and insist that
I get a physical examination from
my physician prior to consuming
the medication and state that I
have made an informed decision to
forego such examination prior to
ordering the medication, but will
get such an examination prior to
using the medication. I also understand
that after a non-medical professional
(who is NOT a doctor and does not
have the power or knowledge to diagnose,
prescribe or recommend any medication
or course of treatment) has seen
my completed questionnaire and decided
to refer me to another web site
which sells medications, I agree
that RxGenesis / Curaderm DOES NOT
provide any medications or tangible
products of any kind and as such
is unable to accept returns or issue
refunds for any orders of prescription
drugs bought by referral from this
web site to any other business.
I agree to be responsible for all
customs, tariffs, and taxes applicable
to my country. I have read and understood
the Waiver, Release and Representations
and Warranties and agree to all
the foregoing terms in their entirety.
I FULLY ACKNOWLEDGE, UNDERSTAND
AND AGREE THAT I AM NOT RECEIVING
THE ADVICE OF A REAL QUALIFIED DOCTOR
OR HEALTHCARE PROFESSIONAL AND THAT
EVEN IF I AM REFERRED TO ANOTHER
WEB SITE DISPENSING MEDICATIONS
I SHOULD ONLY USE THESE MEDICATIONS
AFTER CONSULTING A REAL DOCTOR IN
PERSON WHO IS QUALIFIED AND LICENSED
TO PRACTICE IN MY COUNTRY. I FULLY
ACKNOWLEDGE, UNDERSTAND AND AGREE
THAT I WILL RECEIVE NO MEDICAL ADVICE
AT ALL AND SHOULD NOT ACT ON ANY
ADVICE, INFORMATION OR REFERRAL
GIVEN ON THIS WEB SITE OR BY ITS
RELEASED PARTIES.
This information is provided solely
for educational and informational
purposes including as a potential
guideline to be used when discussing
a program with a healthcare professional
and not as an alternative to qualified
medical advice. I understand that
I have not been given nor will be
given either at present or at any
time in the future any medical advice,
pharmacological advice, health advice
or medical diagnosis that I should
act on.
ACCEPTANCE
OF TERMS:
IN PURCHASING THIS ITEM I ACCEPT
THE TERMS AND CONDITIONS
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