MEDminder™ Card Request Form

Asterisk (*) indicates a required field.

Contact Information
Patient Information

Please specify the generic/common name and the trade name, if known.

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Design Your MEDminder™ Card

MEDminder™ is an optional service offered to St. Jude patients. Since the St. Jude Pharmacy is not directly providing the service, St. Jude cannot promise, represent, or warrant that the information provided is accurate or complete. For questions about the accuracy of the medicine list, please talk with your personal doctor. By providing information and education, our aim is to encourage you to take an active part in your care and treatment Questions about individual health concerns or specific treatment options should be discussed with your doctor. In no event will St. Jude be liable to you or to any third party for inaccurate or incomplete data, lost data or other damages of any kind arising out of the use or inability to use this service.

I have carefully checked for spelling and content and I understand that this information will print exactly as it was entered into the request form. Updates or changes to the MEDminder™ card will require a new form to be submitted.