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I certify that I am 'over 18 years' and that I am under the supervision of a doctor. The ordered medication is for my own personal use and is strictly not meant for a re-sale. I also accept that I am taking the medicine/s at my own risk and that I am duly aware of all the effects / side effects of the medicine / s. If my order contain tadalafil, I confirm that the same is not meant for consumption in the USA. I acknowledge that the drugs are as per the norms of the country of destination.
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Primary Physician’s Name
Physician’s Telephone No
Drug Allergies * None
Current Medications * None
Current Treatments * None
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Do you Smoke? NoYes
Do you drink? NoYes
The Castle Unit 345 2500 Castle Dr Manhattan, NY
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