Nurtec ODT Savings & Support

Pfizer understands your personal and health information is private. The information you provide will only be used by Pfizer and parties acting on its behalf to send you materials and other helpful information and updates on Nurtec ODT, as well as related treatments, product offers and services.
By checking this box, I verify that I am 18 years of age or older.

By checking this box, you consent to receive autodialed marketing and other texts from Pfizer and its service providers regarding Nurtec ODT at the phone number provided. You understand that providing this consent is not required or a condition of purchasing any products or services. Up to 5 messages/month. Message and data rates may apply. Complete terms can be found at Terms and Pfizer's privacy policy at Privacy Policy. Text STOP to opt out.
By checking this box, I verify that I am 18 years of age or older.

By checking the box below this Authorization, I authorize my health care provider(s) (including pharmacies) and health plans (my "Healthcare Team"), to disclose to Pfizer Inc. ("Pfizer") and its vendors providing services related to my treatment with Pfizer medication (collectively, the "Pfizer Group"), my personal health information, including my contact information and information on my medical condition, treatment, and insurance coverage (collectively, my "PHI") so that the Pfizer Group may use the PHI to (i) assess my qualification for copay support, (ii) provide me with financial and adherence support, (iii) contact me to provide me with information related to my treatment with Pfizer products, including promotional information if I also provide additional consent to receive marketing communications, and (iv) to monitor and evaluate the implementation and effectiveness of the services provided by the Pfizer Group. I authorize the Pfizer Group to use my Information, and to share it among themselves and with my Healthcare team, for the forgoing purposes. If I previously provided consent for use and disclosure of my personal health information related to my treatment with Nurtec® ODT to Biohaven, I hereby authorize the use and sharing of that information (including by Biohaven to the Pfizer Group) in the same manner and to the same extent as my PHI as defined above. I understand that once disclosed pursuant to this authorization, my PHI may no longer be protected by federal law and could be re-disclosed to others, but I also understand that the Pfizer Group intends to safeguard my PHI and to use and disclose it only for the purposes described herein.

I understand that I do not need to sign this Authorization in order to receive health care treatment (including with Pfizer products) or insurance benefits, and that I may cancel the Authorization at any time by canceling at nurtec.com/consent. I understand that if I cancel the Authorization, that will not invalidate uses and disclosures of my PHI made before the Program received my notice of cancellation, and that if I do not cancel it, the Authorization will remain in effect for five years from the date upon which I signed this Authorization by checking the box below, or such shorter period as may be prescribed by applicable state law. I understand that I have a right to receive a copy of this Authorization when it is signed.