Licensed Canadian Pharmacy

Patient Agreement

    Note: Please read each item below and select box provided to show that you understand each item. *These must also be completed by the parent or guardian of a minor patient (under age 18). Do not sign this consent and do not take SORIATANE (aka Neotigason; generic name, Acitretin) if there is anything that you do not understand.
    Yes - Proceed to the next statementNo - Skip to statement 5
    I understandI do not Understand
    I am not sexually activeI am sexually active and will use 2 forms of contraceptionI am sexually active and will NOT use 2 forms of contraception
    I understandI do not Understand
    I understandI do not Understand
    I understandI do not Understand