How To Get Aidia - Adhere Tech

Product Eligibility Form

First Name

Last Name

Email address

Phone Number (number to contact)

I am interested in Aidia for:

Myself

A Loved One

Condition(s) being treated:

My current prescribed medications:

Preferred response

Phone

Time of day:

Morning

Mid-day

Evening (up to 8pm ET)

By checking this box and clicking “Submit” you authorize Adheretech to share your personal information with our third party partners such as specialty pharmacies, pharmaceutical manufacturers, patient service providers and related health care entities in order to determine your eligibility for adherence and other related healthcare services provided via AdhereTech to you. You have the right to revoke this authorization at any time by notifying support@adheretech.com but it will not be effective to the extent that any third party has already acted in reliance on this authorization.

By checking this box and clicking “Submit” you agree to be contacted by AdhereTech agents by direct mail, email, telephone, and text message (including autodialed and prerecorded calls and messages—msg & data rates may apply) for marketing purposes and other information related to adherence and other support services from AdhereTech. Your consent is not a condition of any purchase. You may choose to no longer receive further communications from AdhereTech and its agents by emailing unsubscribe@adheretech.com or following the unsubscribe instructions on the communication. For more information, view AdhereTech's Privacy Policy.

Staying On Schedule Starts Here

Aidia is not available for direct purchase