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Patient Agreement (Prescription Medication)


  1. I confirm that I have had a recent appointment with my own doctor.
  2. I require the particular medicines which I have ordered solely for my personal use and I agree not to give, sell or pass them to any other person.
  3. I agree to carefully read all product packaging and labels prior to use.
  4. I understand that I must consult my doctor before taking any new product.
  5. I confirm that I have answered all questions truthfully and to the best of my knowledge.
  6. I understand that if I supply incorrect information it could lead to inappropriate advice being given to me or the wrong medicine being prescribed, which could be harmful to my health.
  7. I have been fully informed and understand the risks, benefits and any possible side effects of the medicines that I request.
  8. Should any complications or side effects develop I agree to immediately contact a doctor for advice or assistance.
  9. I will inform my own doctor about the medicines that I have received.
  10. I confirm that I am 18 years or older.