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Liability Waiver
I hereby state that I am a male over the age of 18 and that I am aware of all the potential side effects associated with Propecia as listed by the United States Food and Drug Administration and Merck & Co., Inc., as listed by Merck at:
www.propecia.com. I understand and agree that any claim arising from, growing out of, or in any way connected with any and all services rendered to me by International Medical Products,
LLC, shall be governed and construed in accordance with the laws of the State of California and the United States of America.
I hereby agree to answer truthfully all of the medical questions on my questionnaire. I understand that falsifying information in order to obtain prescription medication is a violation of both the laws of the State of California and the United States of America.
I understand that no physician, nurse, or administrative personnel can guarantee that Propecia, even if prescribed by a licensed physician, will provide the results I seek. Further, I understand that even if prescribed by a physician, the possibility of adverse effects from Propecia exists.
I also fully understand that if I fail in any way to furnish International Medical Products, LLC with my complete and accurate medical history, or become aware of any changes in the future of which I have not notified International Medical Products, LLC then I cannot hold International Medical Products, LLC responsible for any adverse effects I may suffer.
I hereby covenant and agree, to the maximum extent permitted by law, to indemnify, defend, release, and hold free and harmless International Medical Products,
LLC, its successors and assigns, and its members, directors, officers, agents, employees, and independent contractors, including physicians and each of them, from the following:
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Any claim arising from, growing out of, or in any way connected with any and all services rendered to me by International Medical Products, LLC and/or my use of Propecia;
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Any and all costs, reasonable attorney's fees, expenses, or liabilities incurred in investigating, defending against, or otherwise in connection with losses, claims, damages, liabilities, expenses, or other actions whatsoever associated or connected with any and all services rendered to me by International Medical Products, LLC and/or my use of Propecia; and
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Any and all costs, reasonable attorney's fees, expenses, or liabilities whatsoever associated or connected with any and all services rendered to me by International Medical Products LLC an/or my use of Propecia.
I am submitting the questionnaire at my own choice and my own risk/liability and assume all responsibility for my use of Propecia. I certify that I have a physical examination every year. I fully understand that it is my responsibility to have an annual physical examination and suggested laboratory tests, to ensure that I have no disease which might make Propecia inappropriate for me. I further agree to immediately, before taking Propecia, notify any doctor whose present care I am under that I have chosen to take Propecia so that they may advise me to continue or discontinue use of Propecia. Should I engage a new doctor's care in the future, I further agree to immediately notify said doctor of my use of Propecia.
I understand that International Medical Products, LLC is not a healthcare provider and all healthcare decisions will be made by an independent and licensed physician.
I understand and agree that I shall be solely responsible for ascertaining all import and export regulations in my country with regard to Propecia, and for the payment of any customs, tariffs, and/or taxes associated with said regulations. I further understand and agree that International Medical Products, LLC shall not be responsible in any way for any Propecia distributed to me by International Medical Products, LLC which may be destroyed, seized, or otherwise lost in transit.
International Medical Products, LLC accepts no liability whatsoever for any and all services rendered to me by International Medical Products, LLC and/or my use of Propecia.
In order to continue and for International Medical Products, LLC to provide any services to you, including the consultation and dispensation of Propecia to you, you must agree to the above Waiver of Liability.
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