In consideration of PMSI accepting my medical profile and application to purchase Xenical, and selling me Xenical in the event my application is approved, I hereby certify that I am over the age of 21, am acting of my own volition and am fully aware of the risks and possible consequences of consuming Xenical. In particular,  I certify that I am not taking any medications which are contraindicated with use of Xenical. I hereby release PMSI, its officers, directors, and executive management personnel, administrators, employees, contractor, pharmacies, doctors, successors and assigns, (the "Released Parties") from all actions, causes of actions, suits, sums of money, contracts, controversies, agreements, promises, damages, judgments, executions, claims and demands whatsoever, in law or in equity, which I ever had, now have, or hereafter can, shall or may have against the Released Parties by reason of my purchasing Xenical from  PMSI, and consuming same, with full acknowledgment that I may be releasing claims of which I have no knowledge. I represent and warrant that (1) all the information I provide in connection with my purchase from PMSI is true and correct; (2) I am not taking any medication which is contraindicated with use of Xenical®; (3) I do not have any health condition which would increase my risk of suffering an adverse reaction from taking Xenical®; (4) I understand the Waiver and Release terms above; (5) I will undergo an examination by a physician prior to taking Xenical®; and (6) I am fluent in English and understand everything I am agreeing to, including the complete waiver of any claims I may have against the Released Parties for any reason whatsoever. I also agree (1) to take appropriate and necessary precautions to minimize the risk of an adverse reaction to Xenical®; (2) to seek immediate medical attention in case of such adverse reaction; (3) to immediately stop taking Xenical® following an adverse reaction; and (4) that all services provided to me by any physician included in the Released Parties are deemed to have occurred in the state where the physician is physically located and licensed to practice medicine. I understand that Xenicial does not help everyone with obesity and that not only may it not help me, but I may suffer adverse medical consequences as a result of taking Xencial. I accept these risks because I have a great desire to find a treatment for my obesity and assume the responsibility for my own actions in ordering Xenical over the Internet, without the benefit of a personal, face to face physical examination by a physician. I also understand that the Released Parties strongly recommend that I get a physical examination from my physician prior to consuming Xencial and state that I have made an informed decision to forego such examination prior to ordering Xencial, but will get such an examination prior to consuming Xencial. I also understand that after a doctor reviews my medical questionaire and determines that Xenical® is appropiate for my condition, I hereby authorize a charge to my credit card for the doctors consultation.  I understand that these charges are in addition to the cost of Xenical®. I agree that PMSI is unable to accept returns or issue refunds for any orders of prescription drugs. I agree to be responsible for all customs, tariffs, and taxes applicable to my country. I have read and understood the Waiver, Release and Representations and Warranties and agree to all the foregoing terms in their entirety.