Medical Consent

By submitting this form, I confirm that:

☑ The information I have provided is accurate and complete to the best of my knowledge.
☑ I understand that I am required to have a consultation with a clinician to assess my eligibility for ED treatment and ensure it is safe for me.
☑ I am aware of the potential risks and benefits of ED medication and agree to follow the clinician's guidance.
☑ I understand that if the treatment is deemed unsuitable or unsafe, it may not be supplied.
☑ I agree to sign up with Kingston Pharmacy to process my order.
☑ I have read and agree to the website’s terms and conditions and privacy policy.