b'11.If I have prescription drug coverage that is provided by a private commercial payer and the commercial payer has opted BIOPLUS SPECIALTY PHARMACY PATIENT GUIDEBOOKout of the co-pay Program, I am not eligible to participate. I understand it is my responsibility to verify with my insurance plan any limitations they may have for the use of co-pay cards or other assistance I may use. I shall not accept any co-pay card or other assistance if prohibited by my insurance plan.12. Calls to the pharmacy may be recorded for training, record keeping, and quality assurance purposes. 13.I authorize BioPlus to communicate with me about my medication therapy by email, text message, or other digital com-munictions. If I choose to opt out of communications for marketing or commercial purposes, I understand that BioPlus reserves the right to contact me about the preparation or delivery of my prescription medications. I understand that I may contact the pharmacy at the number on my prescription label with any questions regarding this form.I HAVE READ AND FULLY UNDERSTAND THIS CONSENT TO THERAPY.Patient Name (Patient): ___________________________________________________________________________Patient Signature: _________________________________________________________________________________Former/Alias/Maiden Name (If applicable): ____________________________________________________________Date of Birth: ____________________________________________________________________________________Date: __________________________________________________________________________________________Name of Personal Representative (If applicable): _________________________________________________________Signature of Personal Representative (If applicable): ______________________________________________________Description of Personal Representatives Authority:______________________________________________________Rev. 1/202428 The BioPlus Family of Pharmacies'