By participating in the gammaCore Support Program you authorize Upscript, Upscript Health and/or Bella Brands, LLC to disclose your personal information, including but not limited to, name, address, phone number, email, prescription details and related information (“ID Information”) to electroCore, Inc., the manufacturer of gammaCore. You understand that your ID Information will be used by electroCore to provide you comprehensive support including training and assistance on how to use gammaCore and reminders such as prescription refill reminders.

You understand that once your ID Information is disclosed, it may no longer be protected by federal or state laws regarding patient privacy and it may be subject to re-disclosure without your permission. electroCore agrees to use your ID Information only for the purposes described above or as required by law.

You may revoke your authorization at any time in the future, and your future revocation will not affect your treatment, payment, or eligibility for benefits but may affect your ability to receive gammaCore support. Revoking your authorization will not affect the ability of electroCore to use and disclose ID Information it received while the authorization was in effect. You may revoke your authorization at any time by written notice to:

electroCore, Inc.
200 Forge Way
Suite 205
Rockaway, NJ 07866

or by calling 1-888-903-CORE (2673) and following the instructions provided. This Authorization shall terminate upon conclusion of the gammaCore Support Program or earlier if required by applicable law.