This Patient Acknowledgement must be signed and delivered to EHealth On-Line Ltd. (operating as Discount Pharmacy Direct, DPDRX.com) ("Discount Pharmacy Direct") by any patient ("I" or "me") who is seeking to have Discount Pharmacy Direct arrange for the fulfillment by a licensed Canadian pharmacy of a prescription which has been issued by a non-Canadian physician ("My Own Physician"). In consideration of the services being rendered to me by Discount Pharmacy Direct, the Canadian Physician, EHealth On-Line Ltd. ("EHealth") and the pharmacy engaged to fill my prescription, I acknowledge
and agree as follows:

1. As a precondition to Discount Pharmacy Direct and the pharmacy engaged to fill my prescription being able to fill my prescription I confirm that I have already been taking
the prescribed medication for a minimum period of 30 days immediately prior to the date that I submit my prescription to Discount Pharmacy Direct for filling.
2. Discount Pharmacy Direct and the pharmacy engaged to fill my prescription is required to have a licensed Canadian Physician (the "Canadian Physician") review my medical information for the purposes of independently verifying whether the medications prescribed by My Own Physician are appropriate. There are no fees charged to me arising from the Canadian Physician reviewing my medical information.
3. By reviewing my medical information, the Canadian Physician is not rendering or providing any service or advice to me whatsoever. I understand that it is my responsibility
to have My Own Physician conduct regular physical examinations of me, including any and all suggested testing by My Own Physician to ensure that I have no medical problems which would constitute a contradiction to me taking medications prescribed for me by My Own Physician. I agree that should I suffer any adverse affects while taking any prescription medication that I will immediately contact My Own Physician and that in the event I come under the care of another physician, I will inform him or her of any and all medications that I have been prescribed. I acknowledge and agree that Discount Pharmacy Direct recommends regular physician examinations with My Own Physician whose care I am under and who initially prescribed my medications.
4. I hereby give permission to My Own Physician to release any and all medical information and data whatsoever which Discount Pharmacy Direct and the pharmacy engaged to fill my prescription shall request for the purpose of performing a medical review to determine whether the medications prescribed by My Own Physician are appropriate in the circumstances. I understand that this will include reviewing the medical questionnaire and information submitted by My Own Physician and that Discount Pharmacy Direct or its agents and representatives may contact My Own Physician for more information. I hereby give permission to My Own Physician to release my medical files and medical reports as needed to obtain sufficient information for the purpose of such review.
5. I understand that any information provided to Discount Pharmacy Direct may be seen by its employees, agents, contractors and assigns and that this information will constitute a medical record.
6. I understand and agree that Discount Pharmacy Direct is located in the Country of Canada and that the Canadian Physicians and pharmacists working for Discount Pharmacy Direct are located and licensed to practice medicine and pharmacy, respectively, in Canada only and any treatment, if any, that I am receiving from such physicians and pharmacists shall be deemed to be received by me in Canada. I further agree that the proper forum for any proceedings of a legal nature shall be in Canada and I hereby attorn to that jurisdiction. 7. I further understand that Discount Pharmacy Direct will only verify and prescribe medications that My Own Physician has already prescribed to me. No new prescription
medications will be prescribed by Discount Pharmacy Direct. I also understand that no controlled medications, narcotics, tranquillizers, or other medications that the Canadian Physician decides is inappropriate, will be prescribed.
8. I hereby waive any requirement of the Canadian Physician to conduct a physical examination.
9. I understand and agree that the review of my medical information by a Canadian Physician is in no way intended as a means to diagnose any medical condition and does not substitute the requirement for me to obtain my own professional medical advice from My Own Physician. I agree to direct all questions to My Own Physician. I will consult My Own Physician before taking any new drug or changing my daily health regiment. 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.

AUTHORIZATION AND RELEASE CON'T

10. I hereby confirm that I am twenty one years of age or older and that I 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 and understand that it would be a violation of law to falsify any information on my medical questionnaire or other medical records for the purposes of obtaining prescription medication. I agree to truthfully and to the best of my knowledge answer all of the questions on my medical questionnaire. I agree that if I fail in any way to fully furnish my complete and accurate medical history or I become aware of any changes in my physical or medical condition in the future and I fail to notify Discount Pharmacy Direct of such failure, that I am solely responsible for any adverse effects that I may suffer from taking or continuing to take such prescribed medications.
11. I understand that as a patient receiving prescription medication from a Canadian pharmacy I have the right (though am not obligated) to receive counseling from a licensed pharmacist. This counseling would include:

a) Medication identification - what it is and what it is used for. b) Dosage regimen when and how to take the medication. c) Compliance and missing doses - the importance of using the medication correctly and what to do if a dose is missed. d) Proper storage - for medication with special storage instructions. e) Refill information - how many refills are remaining if any
f) Side effects and precautions common side effects as well as rare side effects g) Drug/drug and drug/food interactions - foods and medication (prescription and over the counter) which may interact with the medications currently being taken.
12. I acknowledge that child protective packaging may not be used by Discount Pharmacy
Direct and the pharmacy engaged to fill my prescription and I release and discharge Discount Pharmacy Direct and all of their officers and directors, agents and employees from any and all causes of action with respect to errors or omissions by the company or agency responsible for transporting the ordered product to me.
13. I grant Limited Power of Attorney to Discount Pharmacy Direct and the pharmacy engaged to fill my prescription, for the limited purpose of signing any documents as required by the laws of the Province of the filling pharmacy in Canada, which are necessary to permit the delivery of the product ordered to me, in the same manner as I could, if I had personally attended Discount Pharmacy Direct, EHealth and the pharmacy engaged to fill my prescription places of business in Canada.
14. I certify that I have had a physical examination by My Own Physician within the last 12 months from the date hereof.
15. I agree that the Canadian physician, Discount Pharmacy Direct and EHealth, shall not be liable for any liability, claim, loss, damage or expense of any kind or nature caused directly or indirectly by any inadequacy, deficiency or unsuitability of the prescription issued by the Canadian physician or the inadequacy, deficiency or unsuitability of the Canadian physician's review of my medical information. In no event will the Canadian physician, Discount Pharmacy Direct and EHealth, be liable for or responsible for any damages or costs whatsoever, including, direct, indirect, putative, special or consequential damages, even if advised of the possibility thereof and I hereby release and save harmless these parties and their agents, officers, directors and all related parties from all such damages and costs.
16. As the Customer, I shall hold EHealth On-Line, Ltd., Discount Pharmacy Direct, associated pharmacies, its affiliated and sister companies, divisions, representatives, associates, officers, directors, shareholders, employees and consultants (each, an "Indemnified Party") harmless, and shall release them in perpetuity and/or defend them, against any claim, suit or other proceeding.

I HAVE READ AND UNDERSTAND THE ABOVE REFERENCED PATIENT ACKNOWLEDGEMENT AND AGREE TO EACH OF THE FOREGOING TERMS.

SIGNATURE:_________________________________

PRINT NAME:________________________________

DATE:____________________

MEDICAL PROFILE

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