I am over 18 years of age and hereby declare that I am purchasing this medicine for my own medical use. It will only be used for the treatment of symptoms related to my existing medical condition/ conditions. I am aware of the medical benefits and also the potential side-effects related to Cannabis based products.

I affirm that I am purchasing this product based on a legally admissible prescription given by a registered medical practitioner and I will ensure that this medicine is used by me only under medical supervision. I will not use this product for any recreational activities nor will I engage in any resale activities.

I, my heirs, assigns or anyone acting on my behalf, hold the manufacturer/ supplier free of any harm or any liability resulting from the use of this medicine. I understand that this medicine may affect my co-ordination and cognition in ways that could impair my ability to drive, operate machinery, or engage in potentially hazardous activities. I assume full responsibility for any harm resulting to me or other individuals as a result of its use.