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WAIVER OF LIABILITY
I hereby release Viagra Price for Male Impotence Treatment and all of
their employees and contractors including physicians from
all liability associated with my ViagraŽ consultation and/or
the use of ViagraŽ. I understand that no physician,
nurse or administrative personnel can guarantee that ViagraŽ,
even if prescribed, will provide the results I seek. I hereby
agree to answer truthfully all of the medical questions during
my consultation. I also understand that if I fail in
anyway to furnish Viagra Price for Male Impotence Treatment with my complete and
accurate medical history or become aware of any changes in
the future which I have not notified Viagra Price for Male Impotence Treatment of
then I cannot hold them responsible for any adverse effects
I may suffer.
I realize Erectile Dysfunction (ED) may be caused
by underlying medical conditions such as but not limited to
cancer, diabetes or conditions involving the cardiovascular
system. ViagraŽ may control your (ED) but it does not
treat these possible-underlying conditions. I also understand
that cardiovascular events can be associated with sex and
other strenuous activities with or without the medication.
I am fully aware that it is my responsibility
to have an annual physical exam, including any suggested laboratory
test, to ensure that I have no disease, which might make ViagraŽ
inappropriate for me. I also understand that this consultation
is not a substitute for my need to visit a local physician
for my annual exam. I further agree to notify all physicians,
whose present care I am currently under or any physician who
I will engage in the future, of my decision to use ViagraŽ
so they may advise to continue or discontinue the use of medication.
I further agree if
I am taking nitrates in any form, even occasionally, I should
not take ViagraŽ. Nitrates are found in many prescription
medications that are used to treat angina or chest pain due
to heart disease. I will take precaution concerning
the transmission of sexual diseases and I will seek immediate
medical attention if an erection persists longer than three
hours. I understand that ViagraŽ is to be taken only
once per 24-hour period and the standard dose is 50mg.
Finally, I understand a qualified licensed physician, who
may or may not be licensed to practice medicine in my state,
will evaluate the information I am providing.
If approved, I irrevocably appoint Viagra Price
for Male Impotence Treatment to be my agent and have
my prescription and any refills filled by the Pharmacy
of its choice and acknowledge that the prescription
obtained for me is non-transferable. We are unable to
accept returns or issue refunds for any orders due to
the fact that this is a prescription medication.
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