MyDoseAlert requires you simply complete a form and return to our store, either by fax or in person. To use this free service, you must accept the terms and conditions below, then click the button at the bottom to download the enrollment form!

MY DOSE ALERT TERMS AND CONDITIONS OF USE PLEASE READ THESE TERMS AND CONDITIONS OF USE CAREFULLY BEFORE AGREEING TO UTILIZE THE MY DOSE ALERT SERVICE. IF YOU DO NOT AGREE TO ALL OF THESE TERMS AND CONDITIONS OF USE, DO NOT ENROLL FOR THE MY DOSE ALERT SERVICE. By enrolling in the My Dose Alert Program and executing the Authorization for Use and Disclosure of Health Information, you (“Patient”) have authorized Fritz’s Pharmacy and Wellness Center, Inc. (“Pharmacy”), Pharmacy Development Services, Inc. (“PDS”) and Intelecare Compliance Solutions, Inc. (“Intelecare”) to use and disclose information that may be considered protected health information under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Therefore, Pharmacy’s, PDS’, and Intelecare’s use and disclosure of Patient’s protected health information complies with the provisions of HIPAA. In the event that Patient’s unsecured personal health information, as defined by 42 U.S.C § 17932(h)(1), is breached, or is reasonably believed by Pharmacy, PDS or Intelecare to have been breached, Pharmacy, PDS or Intelecare will notify Patient as required by applicable law. Unfortunately, no data transmission over the Internet or any wireless network can be guaranteed to be 100% secure. As a result, while Pharmacy, PDS and Intelecare strive to protect Patient’s personal information, Pharmacy, PDS and Intelecare cannot ensure or warrant the security of any information that Patient provides in connection with the My Dose Alert service, and Patient provides such information at Patient’s own risk. NOTE THAT THE PHARMACY, PDS AND INTELECARE CANNOT PROTECT ANY INFORMATION ONCE IT HAS BEEN TRANSMITTED TO PATIENT. IF PATIENT SHARES A PHONE NUMBER OR EMAIL ADDRESS WITH ANYONE ELSE (FOR EXAMPLE, A FAMILY MEMBER), INFORMATION TRANSMITTED TO THAT PHONE OR EMAIL ADDRESS MAY BE ABLE TO BE ACCESSED BY THAT OTHER PERSON. PATIENT SHOULD CONSIDER ANY SHARED USE WHEN CREATING PATIENT’S REMINDER WITH THE MY DOSE ALERT SYSTEM. CORRECT/UPDATE: Patient can update Patient’s personal information or dose alert program at any time by contacting the Pharmacy at: Fax attention to: My Dose Alert (888) 767-4151 or e-mail to MyDoseAlert@FritzsPharmacy.com. NOTIFICATION OF CHANGES: If, at any point, Pharmacy, PDS or Intelecare decides to use personally identifiable information in a manner different from that stated at the time it was collected, Pharmacy, PDS or Intelecare will notify Patient. Patient will have a choice as to whether or not Pharmacy, PDS or Intelecare uses Patient’s information in this different manner. Pharmacy, PDS, and Intelecare will use information in accordance with the Authorization for Use and Disclosure of Information and Notice of Privacy Practices under which the information was collected. In the event of a change of these Terms and Conditions of Use, Patient will receive a revised Terms and Conditions of Use. Patient’s continued use of the service after receiving a revised Terms and Conditions of Use shall be deemed as Patient’s acceptance of any changes and the reasonableness of these standards for notice of changes. THE MY DOSE ALERT PROGRAM DOES NOT CONSTITUTE MEDICAL ADVICE AND IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. ALL QUESTIONS RELATING TO PATIENT’S SPECIFIC HEALTH CONCERNS SHOULD BE DIRECTED TO PATIENT’S DOCTOR. IF PATIENT THINKS PATIENT MAY HAVE A MEDICAL EMERGENCY, CALL PATIENT’S DOCTOR OR 911 IMMEDIATELY. Neither Pharmacy, PDS nor Intelecare recommends or endorses any specific medications, procedures, opinions, or other information that may be mentioned on the My Dose Alert website or in their newsletters or other forms of communication. Reliance on any information provided by Pharmacy, PDS, Intelecare or any other third parties through the My Dose Alert service is solely at Patient’s own risk. The My Dose Alert service provides a means for patients and caregivers to receive personal medical reminders based upon the individual needs and input of its users. These reminders are sent electronically through online computer systems. These computer systems may, from time to time despite Pharmacy’s, PDS’ and Intelecare’s best efforts, go offline and may not be able to send reminder messages at the designated time(s) or at all. Patient acknowledges, through Patient’s registration with the My Dose Alert service, that Patient understands and is aware this may happen and agrees not to hold the Pharmacy, PDS or Intelecare liable for any reason, including, without limitation, Patient’s missing a medication dose or failure to receive a reminder created on the system. The service is designed to provide convenience, privacy and information for individuals seeking to create and manage their own personal medical reminders and is intended for informational purposes only. PATIENT’S ACCOUNT OBLIGATIONS: In consideration of Patient’s use of this service, Patient agrees to: (i) provide true, accurate, current and complete information about Patient’s self, and (ii) maintain and promptly update Patient’s medical information to keep it true, accurate, current and complete. If Patient provides any information that is untrue, inaccurate, not current, incomplete, or not Patient’s own, or if Pharmacy, PDS or Intelecare has reasonable grounds to suspect that such information is untrue, inaccurate, not current, incomplete or not Patient’s own, Pharmacy, PDS or Intelecare may suspend or terminate Patient’s use of the service and refuse any and all current and future use of the service by Patient. DISCLAIMERS: PATIENT EXPRESSLY AGREES THAT USE OF THE MY DOSE ALERT SERVICE IS AT PATIENT’S SOLE RISK. NEITHER PHARMACY, PDS INTELECARE, NOR ANY OF THEIR RESPECTIVE AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, THIRD-PARTY CONTENT PROVIDERS, MERCHANTS, SPONSORS, LICENSORS OR THE LIKE (COLLECTIVELY, THE "ASSOCIATES"), WARRANT THAT THE SERVICE WILL MEET PATIENT’S REQUIREMENTS, BE UNINTERRUPTED, OR BE ERROR-FREE. FURTHER, NEITHER PHARMACY, PDS, INTELECARE, NOR ANY OF THEIR RESPECTIVE ASSOCIATES HEREBY MAKE ANY WARRANTY AS TO THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE SERVICE. THE MY DOSE ALERT SERVICE IS PROVIDED ON AN "AS IS," "AS AVAILABLE" BASIS AND PHARMACY, PDS, INTELECARE, AND THEIR RESPECTIVE ASSOCIATES SPECIFICALLY DISCLAIM WARRANTIES OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT. NO ORAL ADVICE OR WRITTEN INFORMATION GIVEN BY PHARMACY, PDS, INTELECARE OR ANY OF RESPECTIVE THEIR ASSOCIATES SHALL CREATE A WARRANTY. ALL INFORMATION PROVIDED BY THE SERVICE OR IN PHARMACY’S PDS’ OR INTELECARE’S EXTERNAL COMMUNICATIONS, INCLUDING INFORMATION RELATING TO MEDICAL AND HEALTH CONDITIONS, PRODUCTS AND TREATMENTS, IS FOR INFORMATIONAL PURPOSES ONLY. SUCH INFORMATION IS OFTEN PRESENTED IN SUMMARY OR AGGREGATE FORM. IT IS NOT MEANT TO BE A SUBSTITUTE FOR THE ADVICE PROVIDED BY PATIENT’S OWN PHYSICIAN OR OTHER MEDICAL PROFESSIONALS OR ANY INFORMATION CONTAINED ON OR IN ANY PRODUCT PACKAGING OR LABELS. PATIENT SHOULD NOT USE THE INFORMATION PROVIDED BY THE SERVICE FOR DIAGNOSING A HEALTH PROBLEM OR PRESCRIBING A MEDICATION. PATIENT SHOULD CAREFULLY READ ALL INFORMATION PROVIDED BY THE MANUFACTURERS OF THE PRODUCTS ON OR IN THE PRODUCT PACKAGING AND LABELS BEFORE USING ANY PRODUCT PURCHASED OR REFERENCED BY THE SERVICE OR THE SUBJECT OF A PERSONAL MEDICAL REMINDER. PATIENT SHOULD ALWAYS CONSULT PATIENT’S OWN PHARMACIST, PHYSICIAN AND MEDICAL ADVISORS. INFORMATION OBTAINED BY USING THE SERVICE OR THE PERSONAL MEDICAL REMINDER SERVICE IS NOT EXHAUSTIVE AND DOES NOT COVER ALL DISEASES, AILMENTS, PHYSICAL CONDITIONS OR THEIR TREATMENT. INFORMATION AND STATEMENTS REGARDING DIETARY SUPPLEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION AND ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE. FURTHER, PHARMACY, PDS AND INTELECARE EXPLICITLY DISCLAIM ANY LIABILITY RELATING IN ANY WAY TO THE ACCURACY, CONTENT OR AVAILABILITY OF INFORMATION FOUNDS ON SITES THAT LINK TO OR FROM THE MY DOSE ALERT SERVICE FROM THIRD PARTIES NOT ASSOCIATED WITH PHARMACY, PDS OR INTELECARE. PHARMACY, PDS AND INTELECARE ENCOURAGE DISCRETION WHEN BROWSING THE INTERNET USE THE MY DOSE ALERT SERVICES OR ANYONE ELSE’S SERVICE. BECAUSE SOME SITES EMPLOY AUTOMATED SEARCH RESULTS OR OTHERWISE LINK USERS TO SITES CONTAINING INFORMATION THAT MAY BE INACCURATE OR DEEMED TO BE INAPPROPRIATE OR OFFENSIVE, PHARMACY, PDS AND INTELECARE CANNOT BE HELD RESPONSIBLE FOR THE ACCURACY, COPYRIGHT COMPLIANCE, LEGALITY, OR DECENCY OF MATERIAL CONTAINED IN THIRD PARTY SITES, AND THE PATIENT HEREBY IRREVOCABLY WAIVES ANY CLAIM AGAIN PHARMACY, PDS OR INTELECARE WITH RESPECT TO SUCH SITES. LIMITATION OF LIABILITY: UNDER NO CIRCUMSTANCES SHALL PHARMACY, PDS, INTELECARE, OR ANY OTHER PARTY INVOLVED IN CREATING, PRODUCING, OR DISTRIBUTING THE MY DOSE ALERT SERVICE BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, PUNITIVE OR CONSEQUENTIAL DAMAGES INCLUDING, BUT NOT LIMITED TO, FOR LOSS OF PROFITS, GOODWILL, USE, DATA OR OTHER INTANGIBLE LOSSES (EVEN IF PHARMACY, PDS, OR INTELECARE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES) THAT RESULT FROM (i) THE USE OF OR INABILITY TO USE THE SERVICE; (ii) THE COST OF PROCUREMENT OF SUBSTITUTE GOODS AND SERVICES RESULTING FROM ANY GOODS, DATA, INFORMATION OR SERVICES PURCHASED OR OBTAINED OR MESSAGES RECEIVED OR TRANSACTIONS ENTERED INTO THROUGH OR FROM THE SERVICE; (iii) UNAUTHORIZED ACCESS TO, OR ALTERATION OF, PATIENT’S TRANSMISSIONS OR DATA; (iv) MEDICAL EXPENSES, INJURY OR DEATH THAT RESULT FROM PATIENT’S MISSING A MEDICATION DOSE OR FAILURE TO RECEIVE A REMINDER THROUGH THE MY DOSE ALERT SYSTEM; OR (v) ANY OTHER MATTER RELATING TO THE SERVICE. PATIENT HEREBY ACKNOWLEDGES THAT THIS PARAGRAPH SHALL APPLY TO ALL CONTENT, MERCHANDISE, AND SERVICES AVAILABLE THROUGH THE SERVICE. BECAUSE SOME STATES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, LIABILITY SHALL BE LIMITED TO THE FULLEST EXTENT PERMITTED BY LAW IN SUCH STATES. CHILDREN'S GUIDELINES & PRIVACY: The My Dose Alert System has not been built or designed for children, nor is the service directed toward children. Although children may use the service, they should not do so without the guidance and approval of a parent or guardian. Although Pharmacy, PDS, and Intelecare do not intend to collect personal information from children, Pharmacy, PDS and Intelecare do intend to comply with state and federal law, including, without limitation, the Children's Online Privacy Protection Act, in the event a child provides such information to us. EXPORT: The U.S. export control laws regulate the export and re-export of technology originating in the United States. This includes the electronic transmission of information and software to foreign countries and to certain foreign nationals. Patient agrees to abide by these laws and their regulations, including, but not limited to, the Export Administration Act and the Arms Export Control Act and not to transfer, by electronic transmission or otherwise, any content derived from the service to either a foreign national or a foreign destination in violation of such laws. OUR RIGHTS: Pharmacy, PDS and Intelecare may elect to electronically monitor areas of the My Dose Alert service and may disclose any content, data or electronic communication of any kind (i) to satisfy any law, regulation, or government request; (ii) to operate the service, if such disclosure is necessary or appropriate to do so; or (iii) to protect Pharmacy’s, PDS’ or Intelecare’s rights or property or the rights of other users, sponsors, providers, licensors or merchants. Pharmacy, PDS and Intelecare are not responsible for screening, policing, editing or monitoring content provided by the My Dose Alert service or included in any personal medical reminder. If notified of allegedly infringing, defamatory, damaging, illegal or offensive content, Pharmacy, PDS or Intelecare may investigate the allegation and determine in their respective sole discretion whether to remove or request the removal of such content from the service or suspend the delivery of personal medical reminders containing such information. Pharmacy, PDS or Intelecare may terminate Patient’s access, or suspend Patient’s access to all or part of the service, without notice, for any conduct that Pharmacy, PDS or Intelecare, in its sole discretion, believes is in violation of any applicable law or is harmful to the interests of another user, a third-party provider, merchant, sponsor, licensor, service provider, Pharmacy, PDS or Intelecare. APPLICABLE LAW: Pharmacy, PDS and Intelecare control the My Dose Alert service from their respective offices within the United States of America. Pharmacy, PDS and Intelecare make no representation that the content in the My Dose Alert service or the services provided through the My Dose Alert Program are appropriate or available for use in other locations. Access to the My Dose Alert Program or its content, and availability of the My Dose Alert Program services provided through the My Dose Alert Program from territories where the service or its content or the service is illegal, is prohibited. Those who choose to utilize the service from other locations do so on their own initiative and are responsible for compliance with applicable local laws. Patient may not use or export the content in violation of U.S. export laws and regulations. Any claim relating to the service, the services provided through the My Dose Alert Program or the content shall be governed by the internal laws of the State of Ohio, without reference to its choice of law provisions. TERMINATION: These Terms and Conditions of Use shall continue in full force and effect for so long as Patient is utilizing the My Dose Alert service. If Patient no longer agrees to be bound by these Terms and Conditions of Use, Patient must cease Patient’s use of the service. Subject to applicable law, Pharmacy, PDS and Intelecare reserve the right to suspend or deny, in each of their respective sole discretion, Patient’s access to all or any portion of the service with or without notice. Patient agrees that any termination of Patient’s access to the service may be effected without prior notice, and acknowledges and agrees that Pharmacy, PDS or Intelecare may immediately deactivate or delete Patient’s account, and all related information and files in Patient’s account, and bar any further access to such files or the service. Further, Patient agrees that neither Pharmacy, PDS nor Intelecare shall be liable to Patient or any third-party for any termination of Patient’s access to the service. GENERAL INFORMATION: These Terms and Conditions of Use and the other documents referenced herein constitute the entire agreement between Patient and the Pharmacy, PDS and/or Intelecare and govern the use of the My Dose Alert service. Patient also may be subject to additional terms and conditions that may apply when Patient uses affiliate services. Pharmacy’s, PDS’ or Intelecare’s failure to exercise or enforce any right or provision of the Terms and Conditions of Use shall not constitute a waiver of such right or provision. If any provision of the Terms and Conditions of Use is found by a court of competent jurisdiction to be invalid or unenforceable, the parties nevertheless agree that the court should endeavor to give effect to the parties' intentions as reflected in the provision, and the other provisions of the Terms and Conditions of Use shall remain in full force and effect. Patient agrees that regardless of any statute or law to the contrary, any claim or cause of action arising out of or related to use of the service must be filed within one year after such claim or cause of action arose or be forever barred. PATIENT AGREES TO INDEMNIFY AND HOLD PHARMACY, PDS AND INTELCARE AND THEIR RESPECTIVE SHAREHOLDERS, MEMBERS, SUBSIDIARIES, AFFILIATES, OFFICERS, DIRECTORS, AGENTS, CO-BRANDERS OR OTHER PARTNERS, AND EMPLOYEES HARMLESS FROM ANY CLAIM OR DEMAND, INCLUDING REASONABLE ATTORNEYS’ FEES, MADE BY ANY THIRD PARTY DUE TO OR ARISING OUT OF ANY SUBMISSION PATIENT POSTS TO OR TRANSMITS THROUGH THE MY DOSE ALERT SYSTEM, PATIENT’S USE OF THE SERVICE, PATIENT’S CONNECTION TO THE SERVICE, PATIENT’S VIOLATION OF THESE TERMS AND CONDITIONS OF USE, OR PATIENT’S VIOLATION OF ANY RIGHTS OF ANOTHER. The section titles in this Terms and Conditions of Use are for convenience only and have no legal or contractual effect. Patient agrees that no joint venture, partnership, employment, or agency relationship exists between Patient and Pharmacy, PDS or Intelecare as a result of these Terms and Conditions of Use or use of the My Dose Alert system or Pharmacy’s, PDS’ or Intelecare’s services. NOTE: IF YOU DO NOT AGREE TO COMPLY WITH THESE TERMS AND CONDITIONS OF USE, PLEASE DO NOT UTILIZE THE MY DOSE ALERT SYSTEM. Patient attests by Patient’s signature on the PATIENT ENROLLMENT FORM / AUTHORIZATION FOR USE AND DISCLOSURE OF HEALTH INFORMATION that the information provided by Patient is in fact true, accurate and complete. Patient also understands that if there is any change in the way that Patient takes Patient’s medication or Patient desires discontinuation of the My Dose Alert system, it is Patient’s responsibility to contact the Pharmacy at MyDoseAlert@FritzsPharmacy.com or fax attention to: My Dose Alert (888) 767-4151.

I ACCEPT the terms and conditions.
I do NOT accept the terms and conditions.