Release to CVS Pharmacy for third-party content
I, the undersigned, hereby authorize CVS Pharmacy, Inc., its subsidiaries and affiliates, and its/their respective licensees, agents, successors and assigns (collectively “CVS”) to use my name, appearance, voice, professional and personal biographical information, and statements made by me in whole or in part and all materials created by or for CVS that incorporate any of these items ("the Materials") in any print or electronic media now or hereafter known, including but not limited to advertising and promotional materials, brochures, audio and video recordings, and/or broadcasts and websites or for any other lawful purpose without further consent from or monetary compensation to me.
CVS will own all rights to the Materials, including copyrights.
Any statements made by me are true and accurate to the best of my knowledge. I hereby release CVS from any and all claims or liabilities relating in any way to the use of the Materials as described herein, including without limitation all claims relating to rights of publicity or privacy.
Authorization form
I give permission to CVS Pharmacy, Inc. on behalf of itself and its subsidiaries and affiliates (“CVS”) to use and disclose my personal health information, including my name and other personal information about me, my medical condition and treatment (“Personal Health Information”). This information may be used and disclosed by CVS for marketing purposes, including to the investor community and to the general public.
This authorization expires three years after I provide consent as shown below. I understand that, once disclosed, my Personal Health Information may no longer be protected by federal privacy law and may be further used and disclosed without my permission. I understand that I am not required to sign this Authorization and that CVS may not condition any treatment, payment, enrollment or eligibility for benefits on whether I sign this Authorization.
I understand that I have the right to cancel this authorization at any time but that any cancellation will not apply to any Personal Health Information that CVS has already used or disclosed based on this Authorization and before it receives my cancellation. I understand that in order to cancel this authorization, I must send a written notice stating that I am cancelling this Authorization to CVS Pharmacy, Inc. Attn: Chief Privacy Officer, One CVS Drive, Woonsocket, RI 02895.
I have had full opportunity to read and consider the contents of this Authorization. I understand that by signing this Authorization, I am giving CVS permission to use and/or disclose my Personal Health Information as described above.