BOTOX ® Savings Program Disclosure. In order for me to participate in Allergan ® ’s BOTOX ® Savings Program, I authorize my health care provider and its agents, as well as other health care providers who may have relevant information for my participation in the BOTOX ® Savings Program, to release and disclose to Allergan ® and Allergan’s agents operating the BOTOX ® Savings Program

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