Terms of Registration

1.The medication is only for you and must never be given to a third party.

2.The medication will be kept out of reach of children.

3.The medication will be used only as directed.

4.The Doctor has the right to refuse medication and / or terminate registration without notification or explanation.

5.You are to read the instruction leaflet before taking medication. The medication is to be taken only as directed in the instructions.

6.The Doctor may require a periodcal re-assessment, at no extra charge.

7.If the client is put on any medications by their own G.P. they are to ask for confirmation that it is safe to mix medications.

The client has not with held any past or present medical history or suspected history or condition of any kind. Particularly the type shown in the medical declaration.

8.All medications are to be paid for before being issued.

9.The Client will inform us IMMEDIATELY of any side effects and stop taking the medication until the Doctor has seen them.


Failure to comply with any of the above will mean immediate withdrawal of registration.

Waiver of Liability

I hereby release Acorn Health and all of its employees and contractors including physicians from any and all liability whatsoever associated or connected with my Viagra/Cialis consultation and/or my use of Viagra/Cialis. I hereby state that I am an adult and that I am aware of the potential side effects associated with Viagra. I hereby agree to answer truthfully all of the medical questions on my questionnaire.

I understand that no doctor, nurse, or administrative personnel can guarantee that Viagra/Cialis, even if prescribed, will provide the results I seek. Further, I understand that even if prescribed, I may suffer adverse effects from Viagra/Cialis. I hereby release Acorn Health and all its employees and contractors including physicians from any and all liability whatsoever associated with any adverse effects I may suffer from my use of Viagra/Cialis.

I am submitting this questionnaire at my own choice, at my own expense, and on my own liability and assume all responsibility for my use of Viagra/Cialis. I fully understand that it is my responsibility to have an annual physical examination, including any suggested laboratory tests, to ensure that I have no disease which might make Viagra/Cialis inappropriate for my condition. I further agree that I have consulted with my present physician and/or pharmacists and hereby warrant that I am not taking any medications or combination of medications that are on the published list of medications which could make Viagra/Cialis so that they may advise to continue or discontinue use. Should I engage a new doctor's care in the future, I further agree to immediately notify the doctor of my use of Viagra/Cialis.