Certification and Warranty of Applicant
I hereby certify and warrant that I am an adult male, will carefully read and truthfully
answer all of the questions in the following questionaire. I further certify that I have
filed this application with the purpose of employing the service of a ViagraSales doctor
and that he will be relying on the truth and accuracy of my answers in determining whether
or not I should have Viagra supplied to me in a prescribed dosage amount.
I further certify and affirm that I am aware of and know of the potentially side effects
of Viagra if I have ingested or taken other medications that are contraindicated for use
with Viagra. I certify truthfully that I have not been taking any such medications.
I also understand that I will receive accurate instructions and printed materials from a
ViagraSales Doctor as soon as possible and that if I have failed in any way to furnish the
ViagraSales Doctor with my complete and accurate medical history or become aware of any
changes in the future of which I have not notified the ViagraSales Doctor, then I have
not, therefore, fulfilled my obligation to promptly notify the physician of any changes in
my history which could materially affect the prescribing of Viagra.
I hereby agree to the foregoing terms and certify that the information therein contained
is correct.
Orders of Liability
I hereby release ViagraSales, its employees, its Doctors, and its dispensing pharmacy from
any and all liability whatsoever associated or connected with my participation in ordering
Viagra to treat my sexual dysfunction.
I also understand that ViagraSales. is unable to accept returns or issue refunds for any
orders of prescription medications. I agree to be responsible for all customs, tariffs,
and taxes applicable to my country.
I have read both the Certification and Warranty of Applicant and the Orders of
Liability and agree to both of them.
