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 JumboRx.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;
JumboRx.com does not practice medicine.
I understand that JumboRx.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 JumboRx.com
and is not an agent or employee of JumboRx.com or its
affiliates. JumboRx.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 JumboRx.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 JumboRx.com,
and that, in addition, JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.com or to the Consulting Physician. This consent
does not give JumboRx.com, its parent or sister companies,
the right to sell my name or information to any third
party.
In consideration of JumboRx.com's undertaking
to render the undersigned patient any administrative or
any other services relating in any way to this agreement,
or JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.com, its officers, directors,
shareholders, affiliates, banking relationships, contractors,
medical laboratories, contracting physicians, medical
protocols, sources of pharmaceuticals, proprietary medical
treatment protocols or JumboRx.com's system of pharmaceuticals
procurement and dispensing, then the undersigned patient
knowingly, expressly and irrevocably consents to a judgment
in favor of JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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 JumboRx.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.
JumboRx.com Disclaimer and User Policy - Please note that
JumboRx.com does not actually prescribe or sell any of
the medications that are shown on this website. JumboRx.com
is only an advertising website. We provide links for our
users to visit on their own accord. When a user leaves
the JumboRx.com website, they are responsible for any
actions that they take from that point. JumboRx.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. JumboRx.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, JumboRx.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, JumboRx.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
JumboRx.com, please refer your questions to the site owners
that are responsible for their own content.
