Personal Importation Declaration & Acknowledgement

(For U.S. Customers)

I, the undersigned recipient, confirm and acknowledge the following regarding my order:

The products in this shipment are intended solely for my own personal use and are not intended for resale, commercial distribution, or use by any other person.
The quantities ordered are limited to amounts appropriate for my personal use.
I understand that personal importation of medicines into the United States may be subject to review by U.S. authorities, including the U.S. Food and Drug Administration (FDA) and U.S. Customs and Border Protection (CBP).
I confirm that I have reviewed the FDA guidance regarding personal importation of medicines.

FDA Reference Information:

Recipient's Full Name:

Order Number:

Signature:

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Date:

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Prescription (Optional)

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