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Medicare Part D Plan Evaluation
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    Aetna PDP, SilverScript Choice...etc,..
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    This should include all blood pressure, asthma, diabetes, etc...medications - But not one time pain medications or antibiotics unless you take them prophylactically.
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    I agree to have my health information contained in this form be included in an email if I selected that in previous question. I understand that this is only a projection of my potential costs and that Vashon Pharmacy is not liable for any changes to plan costs, formularies or changes in healthcare not provided specifically within this form. I understand that Vashon Pharmacy is only providing information regarding my prescription drugs and not considering my medical conditions and/or insurance in any way in this equation. I agree to hold Vashon Pharmacy, its employees and affiliates harmless in any and all matters related to my selection of a Medicare Prescription Drug Plan.
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