By completing and submitting this enrolment form, I acknowledge and agree that:

• Pill4Me Health Solutions may collect and securely store the information provided in this form for the purpose of coordinating medical and clinical care services.
• The information may be shared only with authorized healthcare providers — such as prescribers, counsellors, and laboratory teams — for clinical coordination, OAT prescribing, UDS reporting, and follow-up care.
• No information will be shared with third parties for marketing or commercial purposes.
• All records will be handled in accordance with the British Columbia Personal Information Protection Act (PIPA) and other applicable privacy laws.
• Participation in this program is voluntary, and consent may be withdrawn at any time by contacting Pill4Me Health Solutions.