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CONSULTATION INTAKE

Quick & Convenient

Please complete the confidential online form for consultation services.  Please note, consultation fees apply.  Fees are based on type and duration on consultation.  A Saver Express Pharmacy member will be in contact to confirm pricing and appointment schedule. *ANYTHING WITH AN ASTERISK IS REQUIRED.  IF YOU ARE SEEKING HORMONE CONSULTATION, PLEASE CLICK ON THE BELOW BOX BELOW TO DOWNLOAD AND COMPLETE ADDITIONAL FORMS TO HELP ASSIST IN OUR CONSULTATION.

Consultation Type
Birthday
Gender
Height
Weight (lbs)

PLEASE CLICK THE BOX FOR ALL THAT APPLY:

PLEASE SELECT RELEVANT OVER THE COUNTER MEDICATIONS THAT YOU CURRENTLY TAKE:

FAMILY MEDICAL HISTORY (Please leave blank if unaware of certain family members)

Please use the below to upload any information that you believe could be helpful for your consultation.

PLEASE SCROLL DOWN TO THE BOTTOM TO SIGN AND SUBMIT

PRIVACY POLICY

2024-06-01


At Saver Express Pharmacy, we are committed to maintaining the privacy, accuracy and security of your personal information. We have developed and posted this Privacy Policy to describe our privacy policies and practices, and to inform and provide our customers and those who visit and use the Saver Express Pharmacy website with information about how Saver Express Pharmacy may collect, use, protect and disclose personal information. 


Saver Express Pharmacy wants to assure you that it takes it`s responsibility to deal with personal information and to protect that information very seriously. 


We adhere to and ensure that our privacy practices comply with the provisions of provincial privacy legislation, including, where applicable, the federal Personal Information Protection and Electronic Documents Act and the 10 Fair Information Principles set out therein.

Prior to using our website, and before you provide us with any personal information through our website, we strongly recommend that you carefully read this Privacy Policy.


WHAT IS PERSONAL INFORMATION? 

For the purposes of this Privacy Policy, we consider personal information to be any information that we collect that identifies an individual or can reasonably be used to directly or indirectly identify an individual.


WHAT PERSONAL INFORMATION DO WE COLLECT?

Saver Express Pharmacy collects the personal information that you submit to our website via the intake form. This includes name, address, contact information, medical history, and other personal information.


WHY DO WE COLLECT PERSONAL INFORMATION? 

The purposes for which Saver Express Pharmacy collects your information and the purposes for which you provide Saver Express Pharmacy with your information is identified to you through our website at the time you access our website and, before you provide us with any information, Saver Express Pharmacy collects the information you provide to us through our website to provide you with the consultations, healthcare, products, and pharmacy related services that you request through our website. 


HOW DO WE USE YOUR PERSONAL HEALTH INFORMATION? 

Saver Express Pharmacy uses the information it collects to better provide and improve the quality of the services and products it provides. We may use the information we collect for the following purposes:

  • to document and provide us with information which assists us to better understand the healthcare products and services that you are seeking and that are appropriate for your particular needs and requirements; 

  • to document information concerning the products and services that we have provided to you; 

  • to document information relating to, and the management of, the prescriptions and refills dispensed to you; 

  • to provide you with information, healthcare and pharmacy related services and products; 

  • to assist you with your medical needs and nutritional health, and to ensure that you receive the appropriate medication and nutritional supplements; and 

  • to better manage and develop the Saver Express Pharmacy business.


CONSENT 

By using our website you signify your consent to the contents of this Privacy Policy. By providing us with your information, and your personal information through our website you signify your consent to the contents of this Privacy Policy. 


If you do not agree with the contents of this Privacy Policy; or, if you do not want to provide us with your information and or your personal information; or you do not agree to Saver Express Pharmacy`s collection, use, disclosure and management of your information and or your personal information as described in this Privacy Policy, you may not use our website. By using our website you signify and you are implying your consent to the contents of this Privacy Policy. Implied consent is consent that can be reasonably inferred from your actions. When you provide us with your information and or personal information through our website, we will assume and conclude that you have given us your consent to the collection, use and disclosure of your information, and your personal information for the purposes that you have provided that information, as identified to you at the time you provided it, and, as described in this Privacy Policy. 


As indicated in this Privacy Policy, we may use or disclose your personal information without your knowledge or consent where we are permitted or required by applicable law, regulation or legal process. 

You may withdraw your consent at any time, subject to applicable law and reasonable notice, by contacting a Saver Express Pharmacy pharmacist.


LIMITING COLLECTION, USE, AND RETENTION OF YOUR INFORMATION 

Saver Express Pharmacy limits the information that it collects from you to that specific information it requires to determine and assess, and to provide you with the prescriptions, refills, services and products that you have requested. We will only retain your information so long as it is required to provide you with and so that we may continue to provide you with the products and services that you have requested, or may request in the future, or so long as may be required by law. 


PROTECTING PERSONAL INFORMATION 

Saver Express Pharmacy takes the security of your personal information very seriously and we endeavor to protect it against loss or theft, as well as against unauthorized access, disclosure, copying, use or modification. Although we use industry standard computer and internet security measures and products, and administrative safeguards to protect your personal information, we cannot and do not guarantee the security of your information as no data transmitted over the internet is ever totally or completely secure. Any and all internet use and data transmission is vulnerable and subject to unauthorized third party interception, collection and manipulation. Accordingly, Saver Express Pharmacy cannot and does not represent, warrant or guarantee that personal information will be protected against loss, misuse, interception, manipulation, or alteration and does not accept any liability for any personal information submitted to us over the internet, nor for your or any third parties’ use or misuse of personal information. You acknowledge and agree that Script Pharmacy is not, and shall not, be responsible or liable for any damages or loss of any kind whatsoever that you suffer or may suffer as the result or consequence of you transmitting or sending information of any kind over the internet. 


INFORMED CONSENT FOR HORMONE THERAPY (If Applicable)

In the summer of 2002, the Women's Health Initiative (WHI) released a study regarding the risks and benefits of Hormone Replacement Therapy (HRT). The study involved a hormone replacement therapy named "Prempro". Though other types and brands of hormone replacement therapy were NOT studied, experts reviewing the study have cautioned that there is no evidence that other forms of hormone replacement therapy do not have the same risks.


If you decide to take Hormone Replacement Therapy (HRT), we ask that you read the following:

  1. Though HRT is the best treatment for hot flashes, it is recommended that it be used only for severe hot flashes that you feel justify the risks. If HRT is used for the treatment of hot flashes, it has been recommended by experts reviewing the WHI study, that it be used with the lowest effective dose for the shortest possible duration.

  2. HRT does not appear to prevent heart disease.

  3. HRT has been associated with an increased risk in heart attack, strokes, breast cancer, cancer of the uterus, and blood clots.

  4. Though HRT may be effective in decreasing the risk of osteoporosis, there are other non-hormone treatments that do not have the same risks as HRT.

  5. Though HRT may help relieve vaginal dryness, there are other treatments, including lubricants and vaginal hormone preparations, that are effective and do not have the same risks as HRT.

CALL: (601) 368-8907 / TEXT: (601) 368-8585

1051 Highland Colony Parkway Suite C

Ridgeland, MS 39157 (In The Township)

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Hours: 

Monday to Friday 9 AM to 6 PM

Saturday 9 AM to 12 PM

Sunday Closed

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