| CANADAMEDS.COM CTOMER AGREEMENT (Version 1.5 effective from February 26, 2004) |
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| NO PRESCRIPTION(S) WILL BE FILLED UNTIL A SIGNED AND DATED COPY OF THIS DOCUMENT AND A COMPLETED PATIENT PROFILE HAVE BEEN RECEIVED BY CANADAMEDS (DEFINED BELOW). |
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| I, as the undersigned, being over the age of 21, hereby enter into this agreement (the “Agreement”) with CANADAMEDS (defined below), intending to be legally bound: |
| PART I - DISCLOSURE AND REPRESENTATIONS |
| 1.01 |
I hereby represent and confirm to 3894364 MANITOBA LTD., CARRYING ON BINESS AS “POINT DOUGLAS PHARMACY” AND “CANADAMEDS.COM”, and to each of its affiliates, associates, related companies, subsidiaries and parent company and each of their respective directors, officers, shareholders, successors and assigns (all of such persons are hereinafter collectively referred to as "Canadameds") and to the Canadameds Agents (defined below) that: |
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(a) |
I am delivering this Agreement to Canadameds because I wish to place an order (“My Order”) with Canadameds for certain pharmaceuticals, on the terms and conditions set out herein; |
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(b) |
the pharmaceuticals to be delivered to me in connection with My Order (“My Pharmaceuticals”) were prescribed by a doctor licensed to practice medicine in the country, state or other applicable jurisdiction in which I reside or where I sought treatment; |
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(c) |
the prescription for My Pharmaceuticals (“My Prescription”) was lawfully obtained by me from that physician; |
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(d) |
I will use My Pharmaceuticals strictly according to the instructions provided by the physician who prescribed the pharmaceuticals, as the person for whom such pharmaceutical(s) were prescribed; |
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(e) |
I can make my own medical decisions according to the laws of the place where I reside; |
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(f) |
My Prescription has not been altered in any way nor has it been filled prior to submission to Canadameds. I agree to immediately destroy all copies of My Prescription once it has been filled; |
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(g) |
I am not seeking or relying on any medical information from Canadameds or the Canadameds Agents and I have consulted a qualified physician licensed in the jurisdiction where I obtained My Prescription within the last year; |
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(h) |
I will immediately contact the physician who provided My Prescription in the event I suffer any unexpected side effects from any pharmaceuticals obtained for me by Canadameds; |
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(i) |
I understand that it is my responsibility to have regular physical examinations by my primary 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 Pharmaceuticals; and |
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(j) |
I acknowledge that Canadameds and the Canadameds Agents have relied and will continue to rely on the information and documentation that I am providing to Canadameds (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 Canadameds. I agree to notify Canadameds of any changes to my physical or medical condition by providing an updated Patient Profile. |
| PART II - AUTHORIZATION AND CONSENT |
| 2.01 |
I hereby authorize and appoint Canadameds as my agent and attorney for the limited purpose of taking all steps and signing all documents on my behalf necessary to obtain a prescription in Canada (the “Canadian Prescription”) that is the equivalent of My Prescription, to the same extent as I could do personally if I were present taking those steps and signing those documents myself. This authorization shall include, but not be limited to: collecting personal health information about me; collecting similar information from my prescribing physician or pharmacist; and disclosing that personal health information to Canadameds employees, agents, affiliates and service providers, including without limitation the Canadian physician, any Canadian pharmacy and any Canadian pharmacist being retained by Canadameds on my behalf (collectively, the “Canadameds Agents”), as required, for the limited purpose of obtaining the Canadian Prescription and filling My Order. The authorizations and consents that I am providing herein to Canadameds and Canadameds Agents commence on the date I have signed 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. |
| 2.02 |
Without limiting anything else herein, I hereby provide my consent to allow a physician licensed in Canada retained by Canadameds on my behalf to obtain my medical history, drug history, contact information and other necessary documentation from my physician. In this context, I further consent to both this Canadian physician and my physician being able to contact one another to discuss my medical condition, as it pertains to the prescribing of My Pharmaceuticals. I understand that the reason for this consent is to provide this Canadian 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 physician and to promptly advise the Canadian physician and Canadameds of any changes to my medical condition or prescriptions. |
| 2.03 |
I hereby specifically acknowledge that I am aware that Canadameds will be transmitting my personal health information by electronic means (for example fax or secure internet) to Canadameds Agents. I understand that the use of electronic means will enhance the efficiency and timeliness of processing My Order. I also understand that Canadameds, 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 Canadameds’s transmission of my personal health information by electronic means to Canadameds Agents. |
| 2.04 |
If I was directed to Canadameds’s services through an intermediary (for example Pharmacy Benefit Manager, Health Management Organization or other service provider), I hereby authorize Canadameds 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. |
| 2.05 |
It is my understanding that all such intermediaries will provide confidentiality covenants to Canadameds whereby they agree to hold any such information in strictest confidence and to abide by the privacy policies of Canadameds 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. |
| 2.06 |
I authorize and appoint Canadameds and the Canadameds 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 Pharmaceuticals 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. |
| 2.07 |
I authorize and appoint Canadameds and the Canadameds Agents as my agents and attorneys for the purpose of taking all steps and signing all documents on my behalf necessary for shipping My Pharmaceuticals to me as if I had done so myself. |
| 2.08 |
I acknowledge and agree that I initiated a consultation with Canadameds and that neither Canadameds nor the Canadameds Agents are located in the United States. I also acknowledge that the Canadameds Agents contracted by Canadameds on my behalf are located in Canada and those Canadameds Agents that are physicians or pharmacists are licensed to practice medicine or pharmacy in Canada and that all services that I receive from Canadameds and the Canadameds Agents are being received in Canada. |
| PART III - PURCHASE AND SALE TERMS |
| 3.01 |
Canadameds will charge my credit card the following amounts: |
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(a) |
the pharmaceuticals price and shipping charges (in Canadian dollars or dollars, as determined by Canadameds) as posted on the Canadameds web site on the day Canadameds receives My Order and all other documentation (including the Canadian Prescription) necessary for Canadameds to fill My Prescription; and |
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(b) |
in the event my payment is not authorized, Canadameds has the right to cancel My Order and attempt to provide me with notice of such cancellation. |
| 3.02 |
I acknowledge and agree that: |
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(a) |
My Pharmaceuticals will be packaged in child protected packaging, unless requested by me on the Patient Questionnaire; |
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(b) |
Canadameds and the Canadameds Agents shall be entitled to substitute a brand name prescription drug with a generic prescription drug, where available, unless the physician has indicated that there be "no substitution"; |
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(c) |
once purchased and shipped, no pharmaceutical product may be returned or exchanged; |
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(d) |
Canadameds reserves the right to refuse to assist me in obtaining My Order or any other order in its sole discretion, in which event I will be entitled to a refund for monies paid for such order; |
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(e) |
neither Canadameds nor the Canadameds Agents provide their agency or attorney services as a substitute for healthcare or the advice of my primary care physician; and |
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(f) |
neither Canadameds nor the Canadameds Agents will exchange pharmaceuticals or return any monies paid once an order is filled, unless the pharmaceuticals provided to me by the supplying pharmacy does not correspond with my prescription. |
| 3.03 |
I SPECIFICALLY ACKNOWLEDGE AND AGREE THAT EACH AND EVERY OF THESE TERMS AND CONDITIONS WILL AUTOMATICALLY, AND WITHOUT FURTHER ACTION BY ME OR CANADAMEDS, APPLY TO AND GOVERN ANY FUTURE ORDERS BY ME OF PHARMACEUTICALS FROM CANADAMEDS UNLESS I SPECIFICALLY INDICATE OTHERWISE AT THE TIME OF ORDERING SUCH PHARMACEUTICALS. WITHOUT LIMITING THE FOREGOING, EACH AUTHORIZATION AND CONSENT PROVIDED BY ME IN THIS AGREEMENT WILL CONTINUE UNTIL I REVOKE SUCH AUTHORIZATION OR CONSENT (WHICH I CAN DO AT ANY TIME). |
| PART IV - GOVERNING LAW |
| 4.01 |
I specifically acknowledge and agree that any and all agreements reached or contracts formed throughout the course of any relationship with Canadameds or the Canadameds Agents shall be deemed to be made in the Province of Manitoba, Canada and accordingly shall be governed by the laws of the Province of Manitoba and the laws of Canada applicable to such contracts and agreements. |
| 4.02 |
I specifically acknowledge and agree that any dispute that arises between me and Canadameds or any of the Canadameds Agents shall be governed by the laws of the Province of Manitoba and the laws of Canada applicable to contracts formed in Manitoba, and I agree that the courts of the Province of Manitoba shall have sole and exclusive jurisdiction over any such dispute. |
| I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS SET OUT IN THIS AGREEMENT AND AGREE, ON BEHALF OF MYSELF, MY HEIRS, SUCCESSORS, ADMINISTRATORS AND ASSIGNS, TO BE BOUND BY THESE TERMS AND CONDITIONS. |
