XENICAL®
ORDER PROCESS
Your
original consultation includes four (4) refills over a period
of twelve (12) months. Remember that you may order 90, 180 or
270 pills per prescription. Each prescription is independent
of the other. This allows you to order different quantities
for each refill. To receive a refill please complete the following
steps:
1. Read and agree to the Waiver of Liability.
2. Select the quantity of Xenical® pills.
XENICAL®
PRICES ARE AS FOLLOWS:
120
mg Xenical® Pills
| 90 |
120
mg |
tablets |
1 month
supply |
$199 |
| 180 |
120
mg |
tablets |
2 month
supply |
$359 |
| 270 |
120
mg |
tablets |
3 month
supply |
$499 |
|
WAIVER
OF LIABILITY
I
hereby release www.xenical-fat-blocker.com and all of
their employees and contractors including physicians from all
liability associated with my Xenical® consultation and/or the
use of Xenical®. I understand that no physician, nurse or administrative
personnel can guarantee that Xenical®, even if prescribed, will
provide the results I seek. I hereby agree to answer truthfully
all of the medical questions during my consultation. I also
understand that if I fail in anyway to furnish www.xenical-fat-blocker.com
with my complete and accurate medical history or become aware
of any changes in the future which I have not notified www.xenical-fat-blocker.com
of than I cannot hold them responsible for any adverse effects
I may suffer.
I
realize obesity is associated with the following health conditions,
cardiovascular disease, strokes, diabetes, gallbladder disease,
certain types of cancer, gout (joint pain caused by excess uric
acid), osteoarthritis (deterioration of the joints), sleep apnea
(interrupted breathing during sleep) etc. Xenical® may assist
you with weight reduction but it does not treat these possible
associated conditions.
I
am fully aware that it is my responsibility to have an annual
physical exam, including any suggested laboratory test, to ensure
that I have no disease, which might make Xenical® inappropriate
for me. I also understand that this consultation is not a substitute
for my need to visit a local physician for my annual exam. I
further agree to notify all physicians, whose present care I
am currently under or any physician who I will engage in the
future of my decision to use Xenical® so they may advise to
continue or discontinue use of the medication.
I
understand Xenical® is indicated for obesity management including
weight reduction and weight management when used in conjunction
with a reduced caloric diet. The diet should be nutritionally
balanced and contain approximately 30% of the calories from
fat. I understand secondary to Xenical's® mechanism of action
there is a decrease in the absorption of the fat soluble vitamins
A, D, E, K and beta carotene, therefore physicians recommend
a daily supplemental multivitamin.
I
understand the side effects of Xenical® include but are not
limited to, gas with discharge, fatty or oily stools, an increase
in the frequency of bowel movements and bowel incontinence.
(These side effects are generally mild and resolve early in
treatment) For more information regarding Xenical® please visit
Roche Pharmaceuticals @ http://www.xenical.com. I understand Xenical®
can be taken in conjunction with a mildly reduced choleric diet
up to 3 times per day, the standard dose is 120 mg. Finally,
I understand a qualified and licensed physician who may or may
not be licensed to practice in my state will evaluate the information
I am providing.
If approved, I irrevocably appoint
www.xenical-fat-blocker.com
to
be my agent and have my prescription and any refills filled
by the Pharmacy of its choice and acknowledge that the Rx obtained
for me is non-transferable.
We
are unable to accept returns or issue refunds for any order
due to the fact that this is a prescription medication.