- I hereby authorize and allow inspirehealthpharmacy.com and any of its physicians, employees, associates, and contractors to perform and undertake an on-line medical consultation and evaluation of me for a potential patient for medications. I hereby release inspirehealthpharmacy.com online physicians and all of its employees and contractors including physicians from any and all liability whatsoever associated or connected with my medical Consultation and/or use of prescribed medications.
- I hereby state that I am an adult age 18 or older, I am aware of any possible side effects. And I hereby agree to answer truthfully all of the questions on medical questionnaire provided at inspirehealthpharmacy.com.
- I understand that no doctor can guarantee that medications, even if prescribed, will provide the results I seek. I acknowledge that no guarantees have been made to me as to the results as there is no known medical treatment that gives 100% satisfaction to everyone, nor are there any guarantees against unfavorable results, risks or complications.
- I further acknowledge that if I am prescribed medication, I have full knowledge that no physician, nurse or medical personnel can predict as whether I would or would not have any adverse effects since every individual has a unique biological/chemical make-up. I understand that all possible risks and/or complications do not need to be explained to me, nor do I consider this practical or even possible because risks and complications may occur that have never been recorded before. I hereby release any associated prescribing physicians from any and all liability whatsoever with any adverse effect I may suffer from.
- I am participating in this online consultation at my own choice, at my own expense and my own liability and assume all responsibility for my use of these medications. I acknowledge and agree that I initiated this contact, and I agree that all on-line medical consultations and treatments will be deemed to have occurred in the state or country where the physician is physically located and licensed to practice medicine which may be in another state or country from my own.
- I fully understand that it is my responsibility to have routine physical examination to ensure that I have no disease(s) that might make certain medications inappropriate for my condition. I further agree that I have consulted with my physician and/or pharmacist and hereby warrant that I do not have any conditions or I am not taking any medications that would make a contraindication. I further agree to immediately notify any doctor whose present care I am under that I have chosen to take a certain medication.
- I understand that if I have failed in any way to provide the online consulting physician with my complete and accurate medical history or if I fail to notify the online consulting physician inspirehealthpharmacy.com of any changes in the future, then I can not hold them or its physicians responsible for any adverse effects I may suffer and I am solely responsible for any adverse effects I may suffer from taking or continuing to take medications or from participating in this program.
- I hereby waive a physical exam at this time and agree to continue to have routine medical examinations by my regular physicians. I understand that an on-line medical consultation will NOT include an actual physical exam. I understand that it is my responsibility to have routine physical examinations to ensure that I have no diseases nor contract any conditions that may make taking A medication contraindicated. I further agree to immediately notify any doctor whose present care I am under that I have chosen to take a medication.