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First name

Last name

Date of birth

Gender

Phone number

Street address

City

State

Zip code

Emergency contact name

Emergency contact phone

Department name

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* I Agree to the Privacy and Security Statement. of MIMI-Rx App

MIMI-Rx application empowers you to take control of your health. All MIMI-Rx application users are subject to our Privacy and Security Statement.
MIMI-Rx acknowledges the responsibility of managing your data and is committed to achieving the highest standards of privacy and security.
MIMI-Rx is a HIPAA and HITECH-compliant application. It protects all personal health information entered/added. The data is not shared with 3rd party organizations, and it is stored in a secure environment. This application is patient-centered; you only have the authority to provide access. With your consent, MIMI-Rx/MyVax analyzes your data for personalized reminders, alerts, and notifications.
To complete registration, you must affirm that you have read and accepted the Privacy and Security Statement by checking the above box

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