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When processing this form, please ensure that:

  • You are 18 years of age or older.
  • He has recently had a physical exam and evaluation by a physician authorized to provide medical advice and intervention.
  • He has been advised that you have used this medication successfully and that you are making this request under the supervision of your doctor and that after a medical examination the use of this medication is not detrimental to your needs and treatment.
  • He prescribes this medicine for personal use only and requests that it not be distributed or sold to third parties.
  • Hereby, instead of requesting a prescription approved by this virtual pharmacy, you are requesting this medication prescribed by your doctor.
  • I’m asking for a prescription for this medication to treat what I need, not for the purpose of stockpiling more than I need.
  • I will immediately contact my local physician for any necessary medical intervention if I experience any complications or problems related to the use of the treatment order.
  • The use of a credit card is permitted by law if your request is approved and processed.
  • You have answered and will answer all questions honestly and as if you were under the supervision of a local doctor at the hospital for your own safety.
  • We understand that all medications, including over-the-counter medications, have risks and benefits. Having been informed of the possible consequences, I agree to the terms and conditions.
  • I declare that I understand that Pharmacepticals Inc. will place orders in my name.
  • It is legal to receive the requested medication in your area and I am responsible for the office’s approval and any additional taxes that may apply.
  • You declare that you agree to a delivery time of up to 10 days.
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