Self-declaration for the use of medicines containing Schedule E1 drug

I declare that I am purchasing this medicine for my personal medical use or I am a caretaker of a person who has been prescribed this medication. I confirm that I am buying this medicine based on the prescription given to me by my doctor.

I will ensure that this medicine is used only under the supervision of a certified medical practitioner. 
I want to use this medicine to treat symptoms related to my existing medical condition/conditions. I am well aware of the therapeutic benefits and the side-effects associated with Cannabis formulations.

I, or anyone acting on my behalf, will not hold the manufacturer/supplier responsible for any harm resulting from the medication. I understand that this medicine may affect my coordination and cognition in ways that could weaken my ability to drive, operate machinery, or engage in potentially hazardous activities. I take full responsibility for any harm resulting to other individuals or me as a result of my use of this medicine.

 

I also declare that I will not indulge in any recreational or resale activities around these formulations.

Agree to the above by submitting the form below.
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MANUFACTURER

Mehta Ayurvedic Sansthan

India

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Excise license no. 06/2017-2018

Drug License no. 25D/25/85

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