Patient Authorization
I authorize Amgen and its contractors and business partners
(“Amgen” ) to use and/or disclose my personal information,
including my personal health information, for
the following purposes: to operate, administer, enroll me in and/or continue
my participation in Amgen’s text based digital migraine
tracker and related activities; to provide me with informational and
promotional materials relating to Amgen products and services,
and/or my condition or treatment; and/or to improve, develop, and evaluate
products, services, materials and programs related to my condition or
treatment.
I consent to Amgen contacting me about the text based digital
migraine tracker using the information provided in this form. Amgen may contact me using an automatic dialing machine, prerecorded
voice or SMS/text message (standard text messaging rates may apply).
Reply STOP to cancel messages.
I further understand that the text based digital migraine tracker and
additional informational and marketing communications related to my
condition and treatment are optional and free services. I do not have to
sign this authorization and this authorization in no way affects my right to
obtain any medications. For further information about Amgen’s
privacy practices please see https://www.migraineprivacypolicy.com and for terms
of use, please see www.migrainetermsofuse.com.
By clicking “Submit your info,” I agree to enroll in the text based digital
migraine tracker, and to receive marketing communications from Amgen. I can opt-out at any time.
Program Terms & Conditions
Aimovig’s Migraine Tracker short message service (SMS) symptom tracking
program (the ‘Service’) runs on the short code 246-44. Amgen Inc, will not charge you to use this Service; however
your Wireless Service Provider may charge you for sending and/or receiving
messages and for airtime. Participants will receive recurring messages.
Message and Data Rates may apply.
Service Terms:
To process your requests for this Service, you may be charged a fee to send
and receive messages based on the terms of your Wireless Service Agreement.
All charges are billed by and payable to your Wireless Service Provider.
Check with your Wireless Service Provider if you have questions about your
Wireless Service Plan.
Amgen Inc, will not be liable for any delays in
the receipt of any SMS messages as delivery is subject to effective
transmission from your Wireless Service Provider.
This Service is available on the following carriers: AT&T, Verizon,
Sprint, Virgin Mobile, Boost, T-Mobile, Metro PCS, U.S. Cellular, Aerialink,
Alaska Communications Systems (ACS), Altice Mobile, ASTAC, Atlantic
Tele-Network International (ATNI), bandwidth.com (includes Republic
Wireless), Blue Wireless, Bluegrass Cellular, Brightlink, C Spire Wireless
(aka Cellular South), Carolina West Wireless, Cellcom, Cellular One of N.E.
Arizona, Chariton Valley Cellular, Chat Mobility, Copper Valley Telecom,
Cordova, Cross Wireless, Digital Communications Consulting, Duet Wireless,
East Kentucky Network (Appalachian Wireless), Enflick, GCI Communications,
Google Voice, Illinois Valley Cellular, Inland Cellular, Inteliquent, James
Valley Cellular (JVC), Limitless Mobile, Mid-Rivers Communications,
MobileNation/SI Wireless, MTA Wireless/Matanuska Kenai, MTPCS Cellular One
(Cellone Nation), Nemont CDMA, Nex Tech Communications, Northwest Missouri
Cellular, Panhandle Wireless, Pine Belt, Pine Cellular, Pioneer Cellular,
Rural Independent Network Alliance (RINA), Shelcomm, SouthernLINC, Standing
Rock Telecom, Telnyx, TextMe, Thumb Cellular, Tracfone, Triangle Wireless,
Truphone, Union Telephone, United Wireless, Viaero Wireless, and West
Central Wireless.
T-Mobile is not liable for delayed or undelivered messages.
For questions, please call 1-833-246-6844.
Program Details:
To join Aimovig’s Migraine program go to www.mydailytracker.com or call 1-833-246-6844 to
register. Fill in the required information including your mobile number and
email address. You will receive an opt-in request from the short code. After
you reply with the keyword START you will receive a confirmation message and
be opted into the program.
You will receive recurring questions and alerts. Text HELP
to 246-44 for help, STOP to
246-44 to cancel. Message and Data Rates May
Apply.
TO OPT-IN TO THE SERVICE ON 246-44:
Fill out the registration form at www.mydailytracker.com. Reply START to the message
you receive.
RESPONSE FROM 246-44:
Thanks! You’ll start receiving daily texts tomorrow. Msg&Data rates
may apply. Reply HELP for help. Text STOP to end msgs.
To STOP (OPT-OUT OF) THE SERVICE ON 246-44:
You can cancel receipt of all SMS messages from 246-44 by replying to
any service message, or sending ‘STOP’, ‘STOP ALL’, ‘END’, ‘QUIT’,
‘UNSUBSCRIBE’, or ‘CANCEL’ to
246-44.
STOP RESPONSE:
Thanks for tracking. You’ll no longer receive texts for your migraine
tracker. Reply STOP ALL to opt out of all marketing texts from this sender.
TO GET HELP ON THE SERVICE ON 246-44:
You can get HELP, by replying to any service message, or
sending ‘HELP’ to
246-44.
HELP RESPONSE:
Questions about your migraine tracker? Call 833-246-6844. Reply MD at any
time for the migraine day definition. Reply STOP to end.