Customer Profile and Release
Note: You are now
on our secured server.
All information given to Rx International is required to be held
in the strictest confidence and will not be shared, sold, or traded to any
Fields marked in BOLD
RED are required fields and need to be filled in to process
the account setup.
Please indicate here if you prefer a generic
version of your medication if one is available to have dispensed
through Rx International.
Do you have
any allergies (including drug allergies)?
list all medications (left) you are currently taking and
the condition (right) for which they have been prescribed.
You may be contacted by one of our pharmacists or pharmacy assistants to provide
advice and counsel you on your prescriptions.
To speed up your order,
you can enter your payment information now. Otherwise, send us your prescription and your payment information with your first order.
We are happy to accept Visa, Mastercard, personal checks and money orders.
I appoint Rx International (the "Company") as my agent to:
I agree that medical advice is the sole
responsibility of my U.S. doctor and The Company cannot assess the suitability
or dosage of your prescription. I authorize the Company to disclose the personal
and medical information that I have provided to the doctors and pharmacists the
Company uses and to contact me regarding new information and updates.
By clicking the "I accept" button below, I confirm my understanding and acceptance of those terms and appoint Rx International to act on my behalf to take these steps outlined above.
When you order
from Rx INTERNATIONAL
your prescriptions will be checked more often by more professionals
that any other service available.