PART I – DISPENSING PHARMACY(IES)

1.01      I acknowledge and agree:

1. In the shopping cart/on my order form I have selected, on a product by product basis, which country (the “Selected Country”) I want to purchase My Medications (defined below) from;
   
2. for each product I have ordered, PDP will, as my agent, select a licensed pharmacy (the “Dispensing Pharmacy”) from the Selected Country I want to purchase My Medications from;
   
3. the product(s) being dispensed by a Dispensing Pharmacy will be shipped directly to me by (and I am purchasing My Medications from) the Dispensing Pharmacy;
   
4. it is only those of My Medications that are being dispensed by a Canadian pharmacy that I am purchasing from PDP; and
   
5. if My Medications are being purchased from pharmacies in different countries, they will be shipped separately but should arrive at approximately the same time.

PART II - DISCLOSURE AND REPRESENTATIONS

2.01      I hereby represent and confirm to PDP, and to each of its affiliates, associates, related companies, subsidiaries and parent company and each of their respective directors, officers, shareholders, employees, contractors, subcontractors, successors and assigns and to My Agents (defined below) that:

1. I am delivering this Agreement to PDP because I wish to place an order (“My Order”) for certain medications, on the terms and conditions set out herein;
   
2. the medications to be delivered to me in connection with My Order (“My Medications”) were prescribed by a doctor (“My Doctor”) licensed to practice medicine in the country, state or other applicable jurisdiction in which I reside or where I sought treatment;
   
3. the prescription for My Medications (“My Prescription”) was lawfully obtained by me from My Doctor;
   
4. I will use My Medications strictly according to the instructions provided by My Doctor, as the person for whom they were prescribed;
   
5. I can make my own medical decisions according to the laws of the place where I reside;
   
6. My Prescription has not been altered in any way nor has it been filled prior to submission to PDP. I agree to immediately destroy all copies of My Prescription once it has been filled;
   
7. I am not seeking or relying on any medical information, advice or approval from PDP or My Agents and I have consulted a qualified physician licensed in the jurisdiction where I obtained My Prescription within the last year;
   
8. I will immediately contact My Doctor in the event I suffer any unexpected side effects from any of My Medications;
   
9. I understand that it is my responsibility to have regular physical examinations by my primary US licensed physician that is responsible for my care including all suggested testing to ensure that I have no medical conditions or problems which would constitute a contraindication to me taking My Medications; and
   
10. I acknowledge that PDP and My Agents have relied and will continue to rely on the information and documentation that I am providing to them (including My Order, My Prescription and the Patient Profile) and I represent and confirm that I have fully and accurately disclosed all pertinent information and documentation to PDP. I agree to notify PDP of any changes to my physical or medical condition by providing an updated Patient Profile.

PART III – AUTHORIZATIONS AND CONSENT

3.01      The authorizations, powers of representation and consents that I am providing herein to PDP and My Agents commence on the date I sign this Agreement and will continue until I revoke them. I understand that I can revoke the consents and authorizations I have herein granted at any time.

3.02      I hereby authorize and appoint PDP and My Agents as my agents and attorneys for the limited purpose of taking all steps and signing all documents on my behalf necessary to obtain an Equivalent Prescription (defined below), to the same extent as I could do personally if I were present taking those steps and signing those documents myself. In this Agreement, the term “Equivalent Prescription” means a prescription that (in accordance with Section 1.01 above) is a Selected Country equivalent of My Prescription. This authorization shall include, but not be limited to: collecting personal health information about me; collecting similar information from My Doctor or pharmacist; and disclosing that personal health information to PDP employees, agents, contractors, subcontractors, affiliates and service providers, including without limitation any Agent Physician, any pharmacy and any pharmacist being engaged on my behalf (collectively, “My Agents”), as required, for the limited purpose of obtaining the Equivalent Prescription and My Order being filled.

3.03      Without limiting anything else herein, I hereby provide my consent to allow a physician retained by PDP on my behalf (an “Agent Physician”) in each Selected Country where My Medications are being purchased from to obtain my medical history, drug history, contact information and other necessary documentation from My Doctor. This Agent Physician will be a duly licensed physician in the Selected Country where I am purchasing My Medications. For example, if My Medications are being purchased only in Canada, this Agent Physician will be a licensed Canadian physician; if they are being purchased in more than one Selected Country, an Agent Physician will be engaged in each Selected Country in which My Medications are being purchased, in connection with those of My Medications being purchased in that Selected Country.

3.04      I further consent to each Agent Physician and My Doctor being able to contact one another to discuss my medical condition, as it pertains to the prescribing of My Medications. I understand that the reason for this consent is to provide each Agent Physician with the full opportunity to conduct an independent analysis of whether My Prescription is appropriate, and discuss any potential medical complications that might arise. I further understand that my medical information will not be used for any other reason, and will be kept in strict confidence. I further agree to regularly visit My Doctor and to promptly advise the Agent Physician and PDP of any changes to my medical condition or prescriptions. It is clearly understood that I am not seeking medical treatment or service of any kind from any Agent Physician, PDP or My Agents with regard to any medical advice or treatment of any kind whatsoever. I have relied only on My Doctor in respect of My Prescription.

3.05      I hereby specifically acknowledge that I am aware that PDP will be transmitting my personal health information by electronic means (for example fax, or secure internet) to My Agents. I understand that the use of electronic means will enhance the efficiency and timeliness of processing My Order. I also understand that PDP, as a custodian of my personal health information, will take all appropriate precautions to protect my personal health information from improper disclosure or use. I hereby consent to PDP’s transmission of my personal health information by electronic means to My Agents.

3.06      If I was directed to PDP’s services through an intermediary (for example Pharmacy Benefit Manager, Health Management Organization or other service provider), I hereby authorize PDP to release the following data to such an intermediary: a numerical identifier indicating that I was referred from that source; and financial information that will permit the processing of any claims on my behalf. It is my understanding that all such intermediaries will provide confidentiality covenants to PDP whereby they agree to hold any such information in strictest confidence and to abide by the privacy policies of PDP relating to the protection of my personal health information. I specifically consent to the transmission of the forgoing information to such intermediaries by electronic means.

3.07      Subject specifically to Sections 1.01 above and 5.01 below, I authorize and appoint PDP and My Agents as my agents and attorneys for the purpose of taking all steps and signing all documents on my behalf necessary to package or re-package My Medications and to deliver them to me, to the same extent as I could do if I were personally present taking those steps and signing those documents myself.

3.08      Subject specifically to Sections 1.01 above and 5.01 below, I authorize and appoint PDP and My Agents as my agents and attorneys for the purpose of taking all steps and signing all documents on my behalf necessary for shipping My Medications to me as if I had done so myself.

3.09      I acknowledge and agree that I initiated a consultation with PDP. I also acknowledge that My Agents contracted by PDP on my behalf are located either in Canada or in a Selected Country and those of My Agents that are physicians or pharmacists are licensed to practice medicine or pharmacy in Canada or in a Selected Country, as the case may be, and that all services that I receive from PDP and My Agents are being received (to the extent that My Medications are purchased in Canada) in Canada or (to the extent that My Medications are purchased in a Selected Country) in that Selected Country.