Metformin

H&P Certification — Metformin Tabs

KosherMedications.com
Health & Physical (H&P) Self-Assessment Declaration

By completing my purchase of Metformin through KosherMedications.com, I certify under penalty of perjury that the following statements are true and correct to the best of my knowledge and belief. I understand that a licensed healthcare provider will rely upon this information when determining whether a prescription is clinically appropriate.

General Information

I affirm that I:

  • am 18 years or older, completing this assessment for myself, voluntarily, and providing accurate identifying information including my full name, address, and contact details.

  • will use this service and any prescribed medication solely for myself and will not share or distribute it to others.

  • understand that medications are dispensed only if medically appropriate, based on my self-assessment and provider review.

  • acknowledge that a licensed healthcare provider may contact me for clarification or additional information before approval.

  • have reviewed and accepted KosherMedications.com’s Terms of Service and Consent to Telehealth, which govern my use of this platform and related care.

Consent to Telehealth

I understand and acknowledge that:

  • This service uses an asynchronous telehealth model, allowing me to provide health information online for review by a licensed provider.

  • A valid provider-patient relationship is created for this encounter and may include follow-up communication if needed.

  • Telehealth is a supplemental mode of care and does not replace in-person evaluation or follow-up with my primary provider.

  • Because of the nature of telemedicine, the reviewing provider cannot continuously monitor my condition, lab values, or side effects. I accept these limitations and associated risks.

  • All personal and medical information will be transmitted and stored securely, in compliance with HIPAA and applicable privacy laws.

  • In the event of a medical emergency, I will call 911 or seek immediate in-person emergency care and will not rely on telehealth communication for urgent or life-threatening issues.

Clinical Information Related to Metformin

I confirm that I:

  • am using or requesting this medication for the treatment of Type 2 diabetes mellitus, to help lower blood sugar levels in addition to diet and exercise modifications.

  • understand that Metformin is not indicated for the treatment of lactic acidosis and should be discontinued immediately if lactic acidosis is suspected.

  • am aware of the risk factors for metformin-associated lactic acidosis, including reduced kidney function, age ≥ 65 years, excessive alcohol intake, and concurrent conditions that may reduce oxygen delivery.

  • will discontinue Metformin and seek medical care immediately if I experience symptoms of lactic acidosis such as muscle pain, rapid breathing, abdominal discomfort, unusual fatigue, or dizziness.

  • have not experienced allergic or hypersensitivity reactions to Metformin or its components.

  • do not have severe renal dysfunction (estimated GFR < 30 mL/min/1.73 m²) or other causes of abnormal creatinine clearance such as shock, myocardial infarction, or sepsis.

  • do not have acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.

  • do not have significant hepatic impairment or heart failure, which may increase the risk of lactic acidosis.

  • do not consume excessive alcohol and will avoid alcohol intake while taking this medication.

  • will temporarily discontinue Metformin before any radiological study using contrast dye or surgery that may cause dehydration or hypotension, and will resume only when medically cleared.

  • understand that typical dosing begins at 500 mg twice daily, increasing gradually to minimize side effects, with maintenance doses generally 500 mg – 1 g twice daily.

  • will take Metformin with food to reduce gastrointestinal discomfort.

  • understand that long-term use may reduce vitamin B12 absorption, and I may benefit from periodic B12 supplementation as advised by my provider.

  • am aware that Metformin requires adequate kidney function and may be used with caution if I am 65 years or older, with periodic monitoring of renal parameters.

  • am already using or have previously used Metformin safely for Type 2 diabetes management, as recommended by a licensed provider.

  • am not taking carbonic anhydrase inhibitors (e.g., topiramate) or other drugs that may increase acidosis risk, unless approved by my provider.

Health Status & Representations

I attest that I:

  • am in generally good health, apart from the condition for which I am seeking care.

  • have truthfully disclosed all relevant medical history, medications, and allergies.

  • understand that my submission may be reviewed by a licensed provider, who may reach out for clarification before issuing a prescription.

  • confirm that this certification represents all relevant information I would disclose during an in-person medical visit.

General Information About Prescription Medications

I understand that:

  • This certification does not list every possible precaution, risk, or side effect related to Metformin.

  • I can find more detailed information at:

  • I will review the Medication Guide included with my prescription and consult my healthcare provider if I have further questions.

Pharmacy & Fulfillment Information

I acknowledge that:

  • KosherMedications.com partners with licensed pharmacies to dispense medications in accordance with state and federal law.

  • Reviewing providers act independently and are not employees of the pharmacy.

  • I consent to receive education materials, refill notifications, and updates electronically.

  • I am responsible for reviewing this certification and contacting support@koshermedications.com with any concerns prior to taking my medication.

Emergency Disclaimer

I understand that KosherMedications.com and its affiliated providers do not provide emergency medical services.
In the event of an emergency or severe reaction, I will call 911 or seek immediate in-person care at the nearest emergency department.

By completing my purchase, I affirm that all statements above are true, accurate, and complete to the best of my knowledge.