ADV-CARE Pharmacy Registration Information - Canadian online prescription and OTC drugs store in Ontario

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    New Registration

   To register as a new customer, fill in the form below. Items listed in bold must not be left blank.
   All information will be kept strictly confidential. We will not communicate this information to others as part
   of a mailing list.

Personal Information: Disclaimer and Agree Group Code:

*User Name: *Password:
*Verify Password: Title:
*Last Name: *First Name:
*Birth date: *Gender:

Contact Information:

*City: *State:
*Country: *ZipCode:
*Home Phone: Fax Number:

Doctor Information:

For each Doctor that you are currently under the care of, please record their information on a separate Customs Statement.
Prescribing Doctor's
Last Name:
Prescribing Doctor's
First Name:
Doctor's Phone: Doctor's Fax:
Doctor's E-mail:
Select one: Ask your Doctor to fax your prescription
Mail the orginal prescription

*You are now ready to submit your registration for approval. To submit your registration, click the Submit button.

Prior to submitting my personal profile, I acknowledge that I have read the following Limitation of Liability and Disclaimer and agree that:

I hereby release ADV-Care Pharmacy Inc., including all of its employees, agents, representatives and contractors including physicians, pharmacists, pharmacy technicians, nurses, and receptionists ("ADV-Care") from any and all liability whatsoever associated with or connected to my use of this website, including consultation, the late delivery, non-delivery or missed delivery, and the use of any or all the medications dispensed to me or services provided by ADV-Care and any adverse effects I may suffer from these medications dispensed by ADV-Care. I hereby state that I am at least eighteen (18) years old and am fully competent to make my own health care decisions. I am aware of the potential side effects and/or problems associated with prescription medications, including the medications being dispensed by ADV-Care. I agree to truthfully and to the best of my knowledge enter all of the information on my medical registration.

I understand and acknowledge that because medical diagnoses, treatments, and opinions differ among the very best, well trained, and respected pharmacists, there is no implied warranty that treatments may benefit me. I also acknowledge that medical and pharmaceutical opinions may differ from time to time depending upon many factors such as medical research, conventions, literature, etc. Any and all questions that I have about my prescription medications and their attendant risks have been answered to my satisfaction. I understand all of the material risks and/or complications that may occur.

I also fully understand and agree that by signing this document, I give the licensed Canadian physician who reviews my prescription(s) the right to contact my US prescribing physician(s) with any questions regarding my prescription(s), and/or my medical history. I also agree that if I become aware of any changes in my physical or medical condition in the future and I fail to notify ADV-Care of such changes, then I agree that I am solely responsible for any adverse effects I may suffer from taking or continuing to take these prescribed medications or from participating in this prescription service. I also state that I have had a physical examination by the physician whose care I am under within the last twelve months.

By signing each of these pages of this waiver, or clicking "I AGREE" if being submitted electronically, I agree to release from liability and hold harmless ADV-Care from all claims, actions, causes of action, suits, penalties, liens, judgments, liabilities, obligations, losses, and actual, claimed or consequential damages which may arise at any time by reason of or relating to, arising directly or indirectly out of any matter whatsoever related to the dispensing of my prescription medications or other use of this website.

I understand that it is my responsibility to have regular physical examinations by the physician whose care I am under including all suggested testing by said physician to ensure I have no medical problems, which could constitute a contraindication to me taking the mediations being prescribed and dispensed for me.

I agree that should I suffer any adverse effects while taking these prescribed medications that I will immediately contact the physician whose care I am under. Should I come under the care of another physician, I will inform him or her of any and all medications I am taking.

I hereby give permission to my physician to release my medical files and medical reports to ADV-Care as needed to obtain sufficient information for the purpose of dispensing my medications and share my information with other physician and/or medical PRactitioner.

I acknowledge and agree that I initiated this contract with ADV-Care and that it is located in Canada. I acknowledge that the pharmacists working with ADV-Care are licensed to practice pharmacy in Ontario - Canada. I hereby authorize ADV-Care to redirect my prescription for fulfillment of any medications that are temporarily unavailable in Canada and for all controlled medications that cannot be mailed from Canada, to either a fully licensed US or Global mail order pharmacy partner.

I understand and acknowledge that ADV-Care recommends regular physical examinations and doctor's office visits with my physician. I further understand that ADV-Care will only verify and dispense medications that my physician whose care I am under has already prescribed for me. I also understand that no controlled medications, narcotics, tranquilizers, or other medication the physician decides is inappropriate will be dispensed.

I understand that this service is not in any way intended to diagnose a medical condition. I will direct all questions to my own health care provider. I will consult my own physician before taking any new drug or changing my daily health regimen. I understand that any opinions, advice, statements, services, offers, or other information expressed or made available by third parties (including merchants and licensors) are those of the respective authors or distributors of such content.

ADV-Care reserves the right to change this disclaimer and the medical registration form at any time, including the terms of consultations. You should read this disclaimer every time you place a new prescription order.

Liability in regards to Deception or other Misuse:

In rendering the undersigned patient any administrative or other services relating in any way to this agreement, or disclosing information or methods of treatment to the patient (either deemed to be sufficient consideration for this agreement) then, in the event any court determines that the undersigned patient sought medical treatment or prescriptions for the possible or apparent purpose of deception, or any other misuse, directly or indirectly, the undersigned patient knowingly and expressly consents to a judgment of liquidated damages, against the undersigned patient, in the amount of Five Million Dollars ($5,000,000.00 (U.S.)), which amount is hereby accepted by the undersigned as a reasonable amount for engaging in such acts of deception. If the undersigned patient engages in any of the above-described acts, he/she agrees to pay all reasonable attorney's fees and costs incurred by any legal person seeking to enforce this agreement.
This agreement represents the complete and entire agreement between ADV-Care Pharmacy Inc. and myself. I have read and understood the above-referenced "Patient Disclaimer". I declare that I understand this Disclaimer. I also consent to recieve electronc communications from ADV-Care Pharmacy by phone, e-mail, SMS, fax or any communication means.

Secure Transaction