1. Eligibility & Safety

• I am not pregnant or breastfeeding.
• I am 18 years or older.
• I do not have severe liver disease or a history of severe liver disease.
• I do not have frequent seizures.
• I have no known allergy to Mebendazole.
• I am not currently taking Metronidazole (serious interaction risk).

2. Treatment Purpose & Off-Label Use

• I understand that using Mebendazole for cancer is off-label and not FDA-approved for treatment or prevention of cancer.
• I am requesting Mebendazole as a supportive/adjunctive therapy, not as a standalone or primary treatment for cancer.

3. Coordination With My Oncology Team

• I will inform my oncologist or cancer care provider about my use of Mebendazole and ensure they are monitoring for adverse effects.

4. Monitoring & Side Effects

• I agree to have lab work (CBC, liver panel, kidney panel) after 30 days of treatment and have results reviewed by my provider. This is rare and needed in less than 1% of patients.
• I have reviewed the medication guide: medlineplus.gov/druginfo/meds/a682315.html.
• Possible side effects include abdominal pain, diarrhea, headache, dizziness, rash. Rarely (<1% of patients), hair loss, elevated liver enzymes, bone-marrow suppression, or hypersensitivity reactions may occur.
• I will seek immediate medical attention if I experience severe side effects or worsening of my condition.

5. Identification & Confidentiality

• Uploading a valid government-issued photo ID is a legal requirement to verify my identity before the consultation can be completed.
• This verification complies with state and federal telemedicine regulations.
• My personal information and ID will be handled securely, stored confidentially, and never shared except as required by law or to provide my medical care.

IMPORTANT: Please keep a clear image of your Driver’s License or State ID or Passport (or photo of any government-issued ID) ready on this device to upload.

6. Consent & Risk Acknowledgement

• I consent to evaluation by RightMD Inc. providers and, if appropriate, prescribing of Mebendazole; and I authorize dispensing by RightMD’s partner pharmacies.
• I accept the risks associated with off-label use and understand outcomes are not guaranteed. To the extent permitted by law, RightMD Inc., its providers, pharmacies, and staff are not liable for adverse outcomes arising from my failure to disclose information, non-adherence, or misuse of the medication.

7. Payments & Refund Policy

• All purchases and services are final and non-refundable.

8. Policies

• I have read and agree to the Terms & Conditions, Privacy Policy, and Refund & Cancellation Policy.