Power of Attorney
CheapoDrugs.com operates as a pharmacy broker that specializes in assisting international pharmacies provide patient healthcare at a distance. The following terms and conditions govern dealings between you (“You”) and the authorized dispensary (the “Pharmacy”) regarding the products and services (the “Services”) offered by the Pharmacy.
You herein represents to the Pharmacy that,
“I, being over the age of majority, 1. have fully and accurately disclosed my private health information and consent to its use by the Pharmacy. I have had a face-to-face physical examination by my primary care physician within the last 12 months, and do not require a new examination. 2. I authorize and grant power of attorney to the Pharmacy to take all steps, sign all documents and to act on my behalf as if I were personally present and acting myself for the limited purposes of (a) obtaining a valid prescription for any prescription which I have sent the Pharmacy; and (b) packaging my prescriptions and delivering them to me. This power of attorney shall include authority to: collect and use my private health information as required for the fulfillment of my order, including disclosure to a licensed physician if required for the issuance of a valid prescription in the jurisdiction of the Pharmacy. This authorization may be revoked at any time but shall continue until I revoke it. 3. I understand that all Services shall be offered from and performed by the Pharmacy in its country of licensure and in a manner consistent with the local laws and regulations applicable to that country. 4. I understand that the Pharmacy is legally incorporated and authorized by law to carry on business in its home country, and that I am purchasing medications that have been approved for sale within that country. Title to my medications passes from the Pharmacy to me in the country of the Pharmacy when my medications leave the Pharmacy. All agreements reached or contracts formed with the Pharmacy shall be deemed to be made in the jurisdiction of the Pharmacy, the laws of the jurisdiction of the Pharmacy shall govern all transactions, and I attorn to the courts of the jurisdiction of the Pharmacy, which shall have sole and exclusive jurisdiction over any dispute arising between me and the Pharmacy, its affiliates, officers and directors.”
“I HAVE READ AND UNDERSTAND THESE TERMS AND AGREE THAT THEY SHALL BE BINDING UPON ME ANDMY ASSIGNS, HEIRS AND PERSONAL REPRESENTATIVES.”
“I am the parent/legal guardian/power of attorney for the patient requesting the Services, am over the age of majority, and have full authority to sign for and provide the above representations to the Pharmacy on his or her behalf.”