Electronic signature /Consent to contact

I am agreeing by my electronic signature, to give VeraMed Health (Helping Hand Pharmacy, LLC) my prior affirmative express written consent and permission to call and/or send me SMS text messages at the cellphone number(s) I provided, using an automatic dialing system at any time from and after my inquiry to VeraMed Health. This is to remain compliant with all federal, state, and Do-Not-Call telemarketing laws. I also give my prior affirmative written consent to receive emails at the email address(es) I provided. In each case, VeraMed Health can contact me to market products and services, as well as for all other purposes. I understand that my consent is not required to purchase any of this business’s products or services, and it can be revoked at any time. For SMS message campaigns text STOP to stop, and HELP for help. Terms & Conditions and privacy policy apply.

Statement to permit payment of insurance benefits to provider

I request that payment of authorized Medicare, Medicaid and/or private insurance benefits on my behalf be made to VeraMed Health for any services furnished to me. I authorize any holder of medical ort other information about me to release to veraMed Health, Medicare, and/or my private insurance, and its agents, any information needed to determine these benefits for related services.