What PHI will be used: I authorize NuggMD to use and disclose the following information, collected in my interactions with NuggMD, to affiliates of NuggMD, including affiliate dispensaries, (collectively, “Affiliates”): 1) First and Last Name, 2) Email, 3) Phone Number, 4) Zip and other contact information as provided.

Who will receive this PHI: If I choose to Authorize the release of the above information, it will be shared with Affiliates for purposes of marketing.

Purpose for disclosing this PHI: The purpose for this Authorization is to permit NuggMD and Affiliates to disclose and use the above-listed information for marketing purposes, including contacting me at the contact information provided with promotional and marketing messages about Affiliates’ services and products including, but not limited to, current product prices, coupons, savings offers, sales and discount codes. NuggMD and/or Affiliates may receive direct or indirect compensation in relation to this marketing. I understand that NuggMD and/or Affiliates may contact me using the contact information provided for these purposes.

Your right to revoke authorization: I understand that my Authorization for the release of this information is voluntary. This Authorization may be revoked by sending a request to support@nuggmd.com, except to the extent that actions have already been taken in reliance upon my Authorization. I understand that the information disclosed or used as a result of this Authorization may be re-disclosed by Affiliates and may no longer be protected by applicable privacy laws. I understand that NuggMD may not condition treatment, payment, enrollment, or eligibility for benefits based on this Authorization. I understand that I am not required to give this Authorization, and if I agree to provide this Authorization by clicking the related box, I can obtain a copy of this Authorization at any time by sending a request to support@nuggmd.com.

Expiration of Authorization: This Authorization will remain in effect as long as I obtain services from NuggMD or until I revoke it, whichever occurs first. By checking the related box, I authorize the disclosure and use of all information as outlined above.