Agreement to Participate in SyncRx,
Bremo’s Synchronized Prescription Refill Service
Thank you for your interest in the SyncRx at Bremo Pharmacy.
Advantages of participating in the program include:
- Increased convenience—a single monthly trip to the pharmacy or FREE delivery
- Peace of mind from being able to get medications on time and in one order
- More personal contact with your pharmacist to ask questions and discuss medications
- Increased understanding of your medication, its purpose, potential side effects and costs.
- Your prescription records can be more easily updated to reflect changes in therapy made by doctors or upon hospital discharge.
- Pocket Medication lists available
- Benefits offered: waived packaging fees, waived delivery fees, waived medication disposal fee.
I understand the program’s advantages and the following conditions of participation to achieve the maximum benefits from the service. I hereby agree:
- To pick up medications or accept a delivery on my assigned refill date.
- To keep an open dialogue with my pharmacist regarding doctor’s appointments, hospital/urgent care visits, and changes in my health status, or address.
- To inform the pharmacy of any changes in contact information or address.
- If necessary, to pay an extra copay one time for each medication in order to make all refills due on the same day.
- To have a credit card on file as payment for prescription copays and OTC purchases.
- To accept a monthly phone call from pharmacist to discuss prescription refills.