Thank you for your participation in SimpleScripts. You are on your way to achieving your most positive health outcome! Included below is a list of the many benefits:

• UNDERSTAND the importance of taking your medications correctly and the impact it has on your health.
• DECREASE your trips/calls to the pharmacy each month with medications filled all together at the same time each month*.
• DISCUSS medication costs, questions, and any possible side effects with your pharmacist.
• RECEIVE reminders to review your medication(s) and to pick up your medication(s) when ready.
• FREE delivery or mail for qualifying prescriptions.

I have reviewed and understand the above benefits of SimpleScripts. By agreeing to participate in this service, I also agree to the following:

• I will provide and discuss my current medication regimen with the pharmacy. Any changes or medications I no longer wish to receive are my responsibility to communicate so they are removed from the service.
• I will work with the staff on a regular pick up/delivery/mail schedule. It is my responsibility to communicate any desired changes to the pharmacy staff.
• If picking up, I will pick up my medications each month within 5 days of ready status. Failure to pick up my medications will remove my medications from the service. *Some medications will be filled at different times due to payer requirements. We will do our best to coordinate them with the rest of your medications.

I understand the following communication plan:

• I will receive up to three notifications per medication cycle: confirmation of no changes to medication; medications are ready; medications are overdue to be picked up.
• I will provide my preferred method of communication — phone or text.
• I will notify the pharmacy if there have been any changes to my medication(s) as soon as possible.

For delivery and mail services:
• I will provide a current address, and I understand it is my responsibility to notify the pharmacy of any changes. The pharmacy is not responsible for medication that is sent to the location on record if address changes were not communicated prior to the medication being sent out.
• I will provide a current method of payment for the pharmacy to keep securely on file, to be billed each month prior to mail/delivery of medication. I understand it is my responsibility to notify the pharmacy of any changes and that medications
will not be sent out if payment fails.