NO PRESCRIPTION(S) WILL BE FILLED UNTIL CONFIRMED AGREEMENT TO THE TERMS AND CONDITIONS OF THIS DOCUMENT AND A COMPLETED PATIENT INFORMATION FORM HAVE BEEN RECEIVED BY Canada Pharmacy Delivery. Canada Pharmacy Delivery has established business relationships with licensed pharmacies in Canada and licensed pharmacies or fulfillment centers in other countries, including but not limited to the United Kingdom, Australia, New Zealand, India and Mauritius, that have licensing requirements that are comparable to the ones in Canada. Canada Pharmacy Delivery will select, in consultation with you, the appropriate pharmacy to fill your prescription(s) based on product quality, availability and price.

I, as the undersigned, being the age of 21 or older, hereby enter into this agreement (the "Agreement") with Canada Pharmacy Delivery intending to be legally bound.

I hereby represent and confirm to Canada Pharmacy Delivery, and each of their constituent entities, as well as to each of their affiliates, associates, related companies, subsidiaries and parent companies and each of their respective directors, officers, shareholders, employees, contractors, successors and assigns (all such persons are hereafter collectively referred to as "Canada Pharmacy Delivery" that:

1. I am delivering this Agreement to Canada Pharmacy Delivery because I wish to place an Order(s) with Canada Pharmacy Delivery for certain products which may include pharmaceuticals (the "Order"), on the terms and conditions set out herein;
2. Any pharmaceutical(s) to be delivered to me in connection with my Order (the "Pharmaceutical(s)") were prescribed by a doctor licensed to practice medicine in the country, state or other applicable jurisdiction in which I reside or where I sought treatment;
3. The prescription(s) for the Pharmaceutical(s) (the "Prescription") was lawfully obtained by me from that physician;
4. I will use the Pharmaceutical(s) strictly according to the instructions provided by the physician who prescribed the Pharmaceutical(s), as the person for whom such Pharmaceutical(s) were prescribed;
5. I can lawfully make my own medical decisions according to the law of the place where I reside;
6. The Prescription has not been altered in any way nor has it been filled prior to submission to Canada Pharmacy Delivery. I agree to provide my original Prescription to Canada Pharmacy Delivery, by courier or by mail, in order that my Prescription be filled. I also undertake to immediately destroy all copies of my Prescription once it has been filled;
7. I am not seeking or relying on any medical information from Canada Pharmacy Delivery and I have consulted a qualified physician licensed in the jurisdiction where I obtained the Prescription within the last year;
8. I will immediately contact the physician who provided the Prescription in the event I suffer any unexpected side effects from any of the Pharmaceutical(s);
9. I understand that it is my responsibility to have regular physical examinations by my primary U.S. licensed physician that is responsible for my care, including all suggested testing to ensure I have no medical conditions or problems that would constitute a contraindication to me taking the Pharmaceutical(s) being prescribed; and
10. I acknowledge that Canada Pharmacy Delivery and its employees have relied on the information and documentation that I am providing (including the Order, the Prescription and the Patient Information Form) and I represent and confirm that I have fully and accurately disclosed all pertinent information and documentation to Canada Pharmacy Delivery. I agree to notify Canada Pharmacy Delivery of any changes to my physical or medical condition by providing an updated Patient Information Form.
    
    Authorization and Consent
11. The authorizations and consents that I am providing herein to Canada Pharmacy Delivery commence on the date I sign this Agreement and will continue until I revoke them. I understand that I can revoke the consents and authorizations I have granted at any time by giving written notice to Canada Pharmacy Delivery of my intentions in that regard.
12. I hereby authorize Canada Pharmacy Delivery to take all steps and sign all documents on my behalf to obtain a prescription in the country where the dispensing pharmacy/fulfillment center is located that is the equivalent of the prescription that I sent to Canada Pharmacy Delivery (the "Equivalent Prescription") to the same extent that I could do personally if I were present taking those steps and signing those documents myself. This authorization shall include, but not be limited to, collecting personal health information about me, collecting similar information from my prescribing physician or pharmacist, and disclosing that personal health information to Canada Pharmacy Delivery, its employees, affiliates and service providers, including without limitation the physician licensed in the country where the dispensing pharmacy is located and any pharmacist for the limited purpose of obtaining the Equivalent Prescription and filling my Order.
13. Without limiting anything else herein, I hereby provide Canada Pharmacy Delivery with my consent and the authority to share my personal health information with any physician in the Country where my pharmaceuticals will be dispensed from and to obtain my medical history, drug history, contact information and other necessary documentation from my U.S. physician. I further consent to the physician in the Country where my pharmaceuticals will be dispensed from and my U.S. physician being able to contact one another to discuss my medical condition, as it pertains to the prescribing of my Pharmaceutical(s). I understand that the reason for this consent is to provide the physician in the Country where the pharmaceuticals will be dispensed with the full opportunity to conduct an independent analysis of whether my Prescription is appropriate and discuss any potential medical complications that might arise. I further understand that my medical information will not be used for any other purpose and will be kept in strict confidence. I further agree to regularly visit my U.S. physician and to promptly advise Canada Pharmacy Delivery of any change to my medical condition or prescriptions.
14. I hereby specifically acknowledge that I am aware that Canada Pharmacy Delivery will be transmitting my personal health information by electronic means (for example fax, secure internet) to its employees, affiliates and third-party service providers including the physician in the Country where the pharmaceuticals will be dispensed. I understand that the use of electronic means will enhance the efficiency and timeliness of processing my Order. I also understand that Canada Pharmacy Delivery, as a custodian of my personal health information, will take all appropriate precautions to protect my personal health information from improper disclosure or use. I hereby consent to Canada Pharmacy Delivery's transmission of my personal health information by electronic means.
15. I authorize Canada Pharmacy Delivery and any third-party pharmacy/fulfillment center contracted by Canada Pharmacy Delivery to fill my Order, to take all steps on my behalf necessary to package or repackage my Pharmaceutical(s) and to deliver them to a designated postal authority located outside of the United States to be delivered to me, to the same extent as I could do if I were personally present and taking those steps myself.
16. I understand that Canada Pharmacy Delivery shall take all steps necessary to arrange for the shipping of my Pharmaceutical(s) to me.
17. • a) I acknowledge and agree that I initiated a consultation with Canada Pharmacy Delivery.
    • b) The third-party dispensing pharmacy/fulfillment center contracted by Canada Pharmacy Delivery are located in United Kingdom, Mauritius, India, and Turkey or other countries selected by Canada Pharmacy Delivery from time to time.
    • c) All professional services that I received from any physicians or pharmacists licensed in Canada or other countries, as the case may be, are being received in those jurisdictions of their licensure.
    
    Purchase and Sale Terms
18. Canada Pharmacy Delivery will bill me and debit the relevant payment method (my credit card, bank account, payment draft or other payment method) the following amounts - the pharmaceutical price, shipping charges and any other fees or surcharges (in U.S. dollars) as posted on the Canada Pharmacy Delivery website prior to shipping my Order. I further understand and agree that in addition to the pharmaceutical price, shipping charges, fees/surcharges, my Order may also be subject to certain import-related tariffs currently being imposed by the United States and I agree that it is my sole responsibility to pay any and all tariffs and any related service fees associated with collecting the tariffs that form part of my Order.
19. The Pharmaceutical(s) will not be packaged in child protective packaging, unless otherwise requested by me on the Patient Information Form.
20. Once purchased and shipped, no pharmaceutical product may be returned or exchanged.
21. Title to my prescribed medications and the risk of loss passes from Canada Pharmacy Delivery to me when the Pharmaceutical(s) comprising my Order are received by the designated postal authority located in a jurisdiction outside of the United States for shipment to me.
22. Canada Pharmacy Delivery reserves the right to refuse to assist me in obtaining my Order, or any other order, in its sole discretion, in which event I will be entitled to a refund for monies paid for such Order.
23. Canada Pharmacy Delivery does not provide its services as a substitute for healthcare or the advice of the customer's primary care physician.
24. Unless specified otherwise herein, Canada Pharmacy Delivery will not exchange medication or return any monies paid once an Order is filled, unless the Pharmaceutical(s) provided to me by the dispensing pharmacy/fulfillment center does not correspond with my prescription.
25. It is agreed that the relationship among Canada Pharmacy Delivery, the pharmacy/fulfillment center dispensing my Order and me as the Customer is that of independent contractors and there is no agency, partnership or other relationship among any of the parties.
26. I specifically acknowledge and agree that each and every one of these terms and conditions will automatically and without further action by me or Canada Pharmacy Delivery, apply to and govern any future orders by me of Pharmaceutical(s) from Canada Pharmacy Delivery unless I specifically indicate otherwise at the time of ordering such Pharmaceutical(s) and such amendment is accepted by Canada Pharmacy Delivery in writing. Without limiting the foregoing, each authorization and consent provided by me in this Agreement shall continue until I revoke such authorization or consent (which I can do at any time) in accordance with paragraph 11 above.
    
    Governing Law
27. I specifically acknowledge and agree that any and all agreements reached or contracts formed throughout the course of my purchase of the Pharmaceutical(s) shall be deemed to be made:
    
    
    (a) in respect of any pharmaceuticals that were dispensed in Canada, in the Province of British Columbia, Canada and accordingly shall be governed by the laws of the Province of British Columbia and the laws of Canada applicable to such contracts and agreements; and
    
    
    (b) in respect of any pharmaceuticals that are dispensed in a country other than Canada, the governing law shall be the laws of that respective country from which it was dispensed applicable to such contracts and agreements.
28. I specifically acknowledge and agree that any dispute that arises between me and Canada Pharmacy Delivery or any of the dispensing pharmacies that fill my Order shall:
    
    
    (a) insofar as such dispute relates to Canada Pharmacy Delivery or any pharmacy that has filled my Order, be governed by the laws of the Province of British Columbia and the laws of Canada applicable to contracts formed in British Columbia; and
    
    
    (b) insofar as such dispute relates to any dispensing activity that took place outside of Canada, such dispute shall be governed by the laws of the country from which the shipment was dispensed applicable to such dispute;
    
    
    (c) it is understood and agreed that all disputes of any kind shall be exclusively resolved through binding arbitration pursuant to the ADR Institute of Canada Rules.
I have read and understood the terms and conditions set out in this Agreement and agree, on behalf of myself, my heirs, successors, administrators and assigns to be bound by these terms and conditions. I acknowledge and agree that my acceptance of this Agreement is evidenced by either (a) selecting the “I have read, understood, and agreed to all terms and conditions of the Customer Agreement” checkbox during the account creation process, or (b) executing this Agreement below and returning it to us, and that such acceptance constitutes a legally binding agreement to these Terms and Conditions.


Signed this ______ day of ___________, 2026.



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Witness	Signature
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Name of Witness (Please Print)	(Customer #)