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If I cancel my consent, I will no longer qualify for the services described.I also understand that if a Health Care Provider is disclosing my personal health information to Amgen on an authorized on-going basis, my cancellation with Amgen will be effective with respect to any such Health Care Providers as soon as they receive notice of my cancellation.If you’d like to learn about other options that may help you pay for ENBREL, please call us at 1-888-4ENBREL (1-888-436-2735).In addition to the below consent, I understand that by checking this box and by checking “I accept” [below], I consent to Amgen calling and texting me at the phone number(s) I have provided with promotional communications relating to Amgen products and services and/or my condition or treatment.™ program is educational only and is not intended to diagnose health problems or provide medical advice or medical care.Please talk to your doctor if you have questions about your medical care or treatment.™ program is educational only and is not intended to diagnose health problems or provide medical advice or medical care.Amgen may use automatic dialing machines or artificial or prerecorded messages to contact me and may leave a voicemail or SMS/text message (standard text messaging rates may apply).I understand that I am not required to provide this consent as a condition of purchasing any goods or services.

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adherence programs) and other patient support services.Expiration, Right to Obtain a Copy and Right to Cancel I understand that by signing this form, I authorize my Health Care Providers or others who might hold my health information to only release it to Amgen employees, as well as to its contractors and business partners, who are performing the services set forth in this Authorization.I also understand I am authorizing my personal information, including my personal health information, to be used for the purposes described above.I understand and agree that by signing below, I am authorizing those who rely on this Authorization to release my personal health information for the earlier of five (5) years or until my participation in the program ends through my cancellation, unless a shorter time period is required by state law.I understand that I can obtain a copy of this Authorization or cancel this Authorization at any time by calling Amgen at 1-888-4ENBREL (1-888-436-2735) or by writing to PO Box 7249, Bedminster, NJ 07921.