I accept, understand, and agree to
the following: I am freely seeking medical consultation
via the Internet and I am aware that the physician
reviewing my medical history will not have the opportunity
to conduct a personalized in-person physical examination;
I am soliciting this site because
I am seeking a specific prescription medication
to treat an already-identified medical or cosmetic
condition;
I understand that my "Medical History
Questionnaire" will be reviewed by a physician who
is licensed in the U.S. I acknowledge and agree
that I, under no undue duress, initiated contact
with HonestRx.com. I am aware that my prescribing
physician may be located in another state or country
other than my own and that said physician may NOT
be licensed to practice medicine in my state of
residence (referred to as the ("Consulting Physician");
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.
I am under the care of a primary care
physician and I do not consider the Consulting Physician
to be my primary care physician (unless I visit
said physician for an in-person personal doctor/patient
consultation). I will not rely on or substitute
the advice given by the Consulting Physician should
it contradict the advice given to me by my primary
care physician;
I will not make a claim that the Consulting
Physician acted unprofessionally or below the standard
of care solely because the physician did not personally
perform a physical examination on me;
The Consulting Physician reviewing
my "Medical History Questionnaire" will make a decision
based upon my honest responses in making his or
her decision regarding my request. I understand
each question I answered on the questionnaire was
responded to truthfully, accurately and completely.
I also understand that failure on my part to provide
truthful, accurate and complete information to the
Consulting Physician could cause him or her to unknowingly
make an inappropriate treatment decision affecting
my physical or mental health. To prevent this occurrence,
I acknowledge that it is of utmost importance that
I am truthful when answering the questions asked
in the "Medical History Questionnaire";
Before taking any medication prescribed,
I will ensure that I have completed the following:
accurately and honestly completed a comprehensive
physical examination by my primary care physician;
that I received a copy of the written report of
said examination, and that I have identified my
responses to the "Medical History Questionnaire"
any findings from my physical examination that are
not within the accepted average range;
HonestRx.com does not practice medicine.
I understand that HonestRx.com is a Management Service
Organization that received my request for a physician
consultation and, in turn, directs that request
to a qualified independent physician for review
and response. The physician who reviews my medical
history and who makes the medical determination
as to whether or not I receive the medication I
am seeking is solely an independent contractor of
HonestRx.com and is not an agent or employee of
HonestRx.com or its affiliates. HonestRx.com does
not direct, control or influence the treatment decisions
made by the Consulting Physician with respect to
my care and/or my request from HonestRx.com is not
liable for any negligent act or omission of the
Consulting Physician;
I understand that my medical record
becomes the property of the Consulting Physician
or HonestRx.com, and that, in addition, HonestRx.com
will have continuing access to and the right to
copy and retain any and all portions of my medical
record;
I am over 18 years of age;
I am soliciting this site to determine
whether or not I fit the criteria for certain prescription
medications. I am not currently seeing my regular
primary care physician at this time because: a)
this site is more convenient, b) for other personal
reasons;
I agree that any dispute arising out
of or related to the provision of services by the
Consulting Physician, by HonestRx.com, its affiliates,
or their employees, partners and agents, shall be
subject to mandatory mediation. Should mediation
fail to resolve the disputable issue(s), said dispute
shall be subject to final and binding arbitration,
as set forth in the United States Arbitration Act.
In accordance with the United States
Arbitration Act, I agree that any dispute arising
out of or related to the provision of services by
the Consulting Physician, by HonestRx.com, its affiliates,
or their employees, partners and agents, shall be
subject to final and binding arbitration exclusively
through the Procedures of the American Arbitration
Association. I understand that this agreement is
voluntary and that it is binding to any individual
or entity claiming by or through me or on my behalf;
and I chose this site on my own accord from several
Internet options;
Any mediation, arbitration, administrative
proceeding, complaint, court proceeding, or other
proceeding pertaining in any way to this site must
be held in the County of Nevada, City Grass Valley,
and in no other forum in any other place. This Informed
Consent expressly includes knowing consent to transfer
the venue of any dispute of any kind to the above
city and county for resolution.
I hereby release HonestRx.com and
the Consulting Physician from all claims that the
Consulting Physician acted unprofessionally or below
the standard of care solely because he/she did not
perform a physical examination on me.
This release includes, but is not
limited to, my agreeing to the following:
I have truthfully answered all of
the questions and have provided complete and accurate
answers to the questions. I further agree to make
the HonestRx.com physicians aware of any changes
in my medical condition in the event I revisit this
site to obtain more or different medication;
I am aware of potential side effects
associated with this medication. I personally accept
all risks involved in taking medication and will
not seek any indemnification, any damages of any
kind, or any other liability from HonestRx.com,
its parent, subsidiaries, affiliates, contractors,
or partners, if I experience any of the side effects;
I understand that no doctor, nurse,
or administrative personnel can guarantee that the
prescription medicines I am requesting will provide
the results I seek;
It is my responsibility to have an
annual physical examination, including any suggested
laboratory tests, to ensure that I do not have a
condition which will make my taking this medication
inappropriate or dangerous;
I have consulted with my physician
and/or pharmacist and am not currently taking any
medications or combination of medications that will
make the medication I am requesting inadvisable
to take (contraindicated); and, I will notify my
primary care physician that I am taking the medication
that I requested so that he/she may advise me as
to whether or not I should continue or discontinue
its use.
This document also serves as my informed
consent to allow HonestRx.com access to any of my
medical information, including all medical data
contained in the "Medical Records 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 Physician to release or disclose
to HonestRx.com any and all Medical Information.
I accept that, with the exception for action formerly
taken with regard to this authorization, I can void
this authorization at any time by providing notices
to HonestRx.com or to the Consulting Physician.
This consent does not give HonestRx.com, its parent
or sister companies, the right to sell my name or
information to any third party.
In consideration of HonestRx.com's
undertaking to render the undersigned patient any
administrative or any other services relating in
any way to this agreement, or HonestRx.com disclosing
information or methods of treatment to patient (either
of which are deemed sufficient consideration for
this agreement) then, in the event any court determines
that the undersigned patient sought medical treatment
or medical prescriptions through HonestRx.com for
the possible or apparent purpose, directly or indirectly,
of deception, assisting any investigation, or rendering
of any type of assistance to, or disclosing of any
information pertaining to HonestRx.com, its procedures,
officers, directors, or medical protocols, to any
news organization, possible or actual competitor,
any type of governmental agency, any investigator
or any party for possible or apparent purposes of
securing any information, confidential or otherwise,
about HonestRx.com, its officers, directors, shareholders,
affiliates, banking relationships, contractors,
medical laboratories, contracting physicians, medical
protocols, sources of pharmaceuticals, proprietary
medical treatment protocols or HonestRx.com's system
of pharmaceuticals procurement and dispensing, then
the undersigned patient knowingly, expressly and
irrevocably consents to a judgment in favor of HonestRx.com,
its officers, or any party proceeding under the
authority of this instrument, of liquidated damages,
jointly and severally against the undersigned patient,
as well as any express or apparent principle (including
patients employer) as an authorized or apparent
agent of his/her principle or employer, in the amount
of Three Million Dollars ($3,000,000.00), which
liquidated damage amount is hereby accepted by the
undersigned as a reasonable amount for engaging
in such acts of deception and because they are difficult
to ascertain. The undersigned patient engaged in
such deception or any of the above described acts,
agrees on behalf of himself and his/her principle,
to pay all reasonable attorneys fees and costs
incurred by any person or entity seeking to enforce
this agreement. This agreement represents the complete
and entire agreement between the parties to it.
I understand that all prescription
medications purchased cannot be refunded.
ALL INFORMATION, ITEMS, AND SERVICES
CONTAINED ON THIS WEB SITE ARE PROVIDED "AS IS"
WITHOUT WARRANTY OF ANY KIND, EXPRESSED OR IMPLIED.
IN USING THIS WEB SITE, I UNDERSTAND
AND AGREE; (A) THAT HonestRx.com IS NOT RESPONSIBLE
FOR THE NEGLIGENT OR INTENTIONAL ACTS OR OMISSIONS
OF ANY HEALTH CARE PROVIDER OR SUPPLIER THAT I MAY
BE LINKED WITH OR FOR ANY ACTION OR INACTION TAKEN
BY ME IN RELIANCE UPON THE INFORMATION COMMUNICATED
TO ME VIA THIS WEB SITE; (B) THAT THE TOTAL LIABILITY
OF HonestRx.com AND ITS AFFILIATES, IF ANY, ARISING
FROM OR RELATED TO INTERACTIONS I HAVE WITH OR THROUGH
THIS WEB SITE (WHETHER THE CLAIM IS CONTRACT, TORT,
WARRANTY, NEGLIGENCE, MALPRACTICE, FRAUD, OR OTHERWISE)
IS LIMITED TO THE PURCHASE PRICE OF ANY PRODUCTS
IN ANY RELEVANT TRANSACTION AND (C) THAT HonestRx.com
SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL,
INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES.
IN ACCORDANCE WITH THE ABOVE UNDERSTANDING,
I AGREE TO RELEASE HonestRx.com, THEIR EMPLOYEES,
AGENTS, CORPORATE AFFILIATES AND RELATED PARTIES
FROM ANY AND ALL LIABILITY ASSOCIATED WITH OR ARISING
FROM THE PHYSICIAN CONSULTATION OR FROM THE MEDICAL,
PHYSICAL, BEHAVIORAL OR OTHER EFFECTS OF ANY MEDICATION
THAT MAY BE ORDERED, PRESCRIBED OR PURCHASED AS
A RESULT OF THE PHYSICIAN CONSULTATION.
IF ANY PROVISION OF THIS ABOVE AGREEMENT
IS HELD TO BE VOID, UNENFORCEABLE OR ILLEGAL, THEN
I AGREE THAT THE AGREEMENT WILL BE CHANGED OR LIMITED
ONLY TO THE EXTENT NECESSARY TO ENABLE THE REMAINING
PROVISIONS TO BE OF FULL FORCE AND EFFECT.
HonestRx.com Disclaimer and User
Policy - Please note that HonestRx.com does
not actually prescribe or sell any of the medications
that are shown on this website. HonestRx.com is
only an advertising website. We provide links for
our users to visit on their own accord. When a user
leaves the HonestRx.com website, they are responsible
for any actions that they take from that point.
HonestRx.com recommends that you check your local
laws to ensure that you are not breaking any regulations
by ordering certain types of medications from certain
locations. HonestRx.com caters to an international
audience. Therefore, certain medicines may be listed
on this site that are legal in one country but not
in another. In any case, HonestRx.com recommends
that you consult with your doctor before you buy
or use any of the medications that are listed online.
As an information provider, HonestRx.com cannot
be held accountable for the contents of the websites
that we link to. If you have questions about the
websites that you visit after leaving HonestRx.com,
please refer your questions to the site owners that
are responsible for their own content.
