Patient Responsibility and Compliance Agreement |
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I affirm and state truthfully as if I was under oath that; 1. I am 18 years of age and an adult of sound mind and judgment. 2. I am permitted by the laws in my country to receive the treatment and or medications that I have requested. 3. The prescriptions and medication(s) that I have requested are for my own personal medical needs. I confirm that I require the prescription(s) for a necessary supply of medication and not to stockpile beyond an already adequate supply on hand, or supply to a third party. 4. I have undergone a recent medical examination which was found to be satisfactory by a registered medical practitioner. I have also had my medical history evaluated recently by a local registered Doctor. I further affirm that my local Doctor is available for consultation if the need arises and I agree to contact him/her for any necessary follow-up, care or intervention in the event that I should experience any difficulties or complications or have any questions in respect of the treatment and medication(s). Consumer rights
1. Supplier/Agent*: TrustMedis.co.uk (A service managed by Internet 3C Ltd) 2. Description of Medication*: 3. Emergency Procedure 4. Price: 5. Delivery cost: 6. Payment: 7. Right to cancel: * All prescribed medicines will by supplied and filled by a UK registered pharmacist, pursuant to a prescription issued by a UK registered medical practitioner
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