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and a listing in the
BOTOX® (onabotulinumtoxinA)
Urology Directory

By registering for Urology Essentials®, you will gain access to clinical updates, ongoing support, and educational resources—including patient materials, training videos, and more.

Also included with your registration is a listing in the BOTOX® Urology Directory, a directory of healthcare providers who have experience treating patients with BOTOX®. When you are listed in the directory, patients and referring physicians can find you (by using their ZIP code or city and state).

Already registered for the BOTOX® Urology Directory?
Click here to access your profile.

To edit your Find a BOTOX® Urology Specialist profile, click here.

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In order to access healthcare provider-specific content, your State Medical License must be in good standing. Please provide either your State Medical License or National Provider Identification number below for validation purposes (not for website display).

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A National Provider Identifier or NPI is a unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

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(must include Area Code)
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which will replace the one created here.

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Please fill out the following fields to complete your BOTOX® Urology Directory profile.
This information will be featured in your BOTOX® Urology Directory listing—making it even easier for appropriate patients to find you.


upload your photo (JPG format only)
Location 2 (optional)
Address:
Unit/Suite:
Phone Number:
(must include Area Code)
Fax Number:
(must include Area Code)
City:
State:
Please select state
  • Alabama
  • Alaska
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  • Rhode Island
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  • Tennessee
  • Texas
  • US Virgin Islands
  • Utah
  • Vermont
  • Virginia
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  • Washington D.C.
  • West Virginia
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ZIP Code:
Location 3 (optional)
Address:
Unit/Suite:
Phone Number:
(must include Area Code)
Fax Number:
(must include Area Code)
City:
State:
Please select state
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
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  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Northern Mariana Islands
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • US Virgin Islands
  • Utah
  • Vermont
  • Virginia
  • Washington
  • Washington D.C.
  • West Virginia
  • Wisconsin
  • Wyoming
ZIP Code:

*Allergan owned physician specialty locators

By providing my electronic signature below, I acknowledge and agree to the following:


  1. I acknowledge that the purpose of the FIND-A-Doctor Directory is to provide patients with the business contact information of potential providers of Allergan treatment(s)/product(s) so that patients can have confidence that the provider is purchasing or prescribing Allergan products from authorized, legitimate, and legal sources, and I agree to have my business contact information processed by Allergan and its third-party providers for these purposes;
  2. My participation in the FIND-A-Doctor Directory does not constitute an inducement or reward to me or my medical practice for prescribing, purchasing, or recommending Allergan products;
  3. I have reviewed the current Important Safety Information, including the FDA-approved or FDA-cleared uses, for BOTOX® (hereinafter “the Product”);
  4. I will use the Product in a manner consistent with the FDA-approved or FDA-cleared uses and within my scope of practice as defined by applicable federal and state laws and regulations;
  5. My participation in the FIND-A-Doctor Directory does not constitute an endorsement or recommendation by Allergan of my practice or my use or prescription of the Product;
  6. Allergan may choose to modify or cancel the FIND-A-Doctor Directory, or my participation in the FIND-A-Doctor Directory, at any time and without prior notice to me;
  7. I am subject to the Terms & Conditions for the FIND-A-Doctor Directory that are set forth by Allergan, and Allergan may modify these Terms & Conditions from time to time;
  8. I certify that I am not excluded, debarred, or suspended from participation in, or otherwise ineligible to participate in, any Federal healthcare program or Federal procurement or non-procurement program, and am not subject to any order that may place a limitation on my ability to practice medicine.
  9. I agree to promptly inform an Allergan sales representative or customer service representative in writing of any action that may limit my license in any jurisdiction or makes me ineligible for Federal procurement or non-procurement programs.
Electronic signature:*
*Allergan reserves the right to remove or disable any listing on the BOTOX® Urology Directory at any time for any reason without approval or notice.
LICENSE TERMS AND CONDITIONS

ALLERGAN, INC. AND ITS AFFILIATES, CONTROLLING COMPANIES AND SUBSIDIARIES ("ALLERGAN") ARE WILLING TO LICENSE THE MARKETING MATERIALS AND LICENSED MARKS (EACH DEFINED BELOW) TO YOU AS AN INDIVIDUAL OR COMPANY (REFERENCED BELOW AS "YOU", "YOUR" OR "LICENSEE") ONLY ON THE CONDITION THAT YOU ACCEPT ALL OF THE TERMS OF THIS LICENSE AGREEMENT (THIS "AGREEMENT"). THIS AGREEMENT IS A LEGAL AND ENFORCEABLE CONTRACT BETWEEN YOU AND ALLERGAN. IF YOU ARE AN EMPLOYEE OR AGENT OF A COMPANY (THE "COMPANY") AND YOU ARE ENTERING INTO THIS AGREEMENT TO OBTAIN THE MARKETING MATERIALS FOR USE BY YOU AND/OR THE COMPANY FOR YOURS AND ITS OWN BUSINESS PURPOSES, YOU HEREBY AGREE THAT YOU ENTER INTO THIS AGREEMENT ON BEHALF OF THE COMPANY AND THAT YOU HAVE THE AUTHORITY TO BIND THE COMPANY TO THE TERMS AND CONDITIONS OF THIS AGREEMENT.

BY USING THE MARKETING MATERIALS OR SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS AGREEMENT, UNDERSTAND IT, AND AGREE TO BE BOUND BY IT. IF YOU DO NOT AGREE TO ANY OF THESE TERMS AND CONDITIONS, ALLERGAN IS UNWILLING TO LICENSE THE MARKETING MATERIALS AND THE LICENSED MARKS TO YOU, AND YOU SHOULD MAKE NO FURTHER USE OF THE MARKETING MATERIALS AND LICENSED MARKS, AND RETURN THE MARKETING MATERIALS TO ALLERGAN WITHIN THIRTY (30) DAYS.

1) Definitions: As used herein, the following words, phrases, or terms in this Agreement shall have the following meanings:

"Licensed Marks" means the Allergan trademarks, tradenames and/or service marks included in the Marketing Materials; provided, however, that the appearance and/or style of the Licensed Marks may change from time to time in Allergan's sole discretion.

"Marketing Materials" means the marketing materials for the Products (including Licensed Marks, names and logos contained therein) provided to You by Allergan from time to time in electronic or physical format.

"Products" means the products developed and sold by Allergan that You may promote on behalf of Allergan from time to time.

2) License: Subject to the terms and conditions of this Agreement, Allergan hereby grants to Licensee a non-exclusive, non-transferable, non-sublicensable, royalty-free license to use the Licensed Marks and the Marketing Materials solely in connection with the promotion of the Products.

3) Restrictions: Licensee shall not alter, modify, or create any derivative works of the Marketing Materials except in accordance with this Agreement. Licensee shall not make additional copies of the Marketing Materials beyond what is required under the terms of this Agreement. Licensee shall not remove or obscure any Allergan copyright or trademark notices on the Marketing Materials.

4) Ownership:

a.

The Licensed Marks and the Marketing Materials are owned solely and exclusively by Allergan and are protected by copyright and trademark laws. Allergan retains all right, title and interest in and to the Licensed Marks and the Marketing Materials licensed under this Agreement, and all portions thereof, including, without limitation, all existing and future worldwide copyrights, trademarks, service marks, trade secrets, moral rights, contract rights and other proprietary rights thereto. Other than the license expressly granted in Section 2 above, Licensee receives no right, title or interest in or to the Licensed Marks or the Marketing Materials.

b.

Licensee acknowledges that it is often difficult, particularly in foreign countries, to obtain clear, registered title to trademarks. Accordingly, Licensee agrees that the rights granted herein exist only to the extent that Allergan owns such rights, and no warranty, express or implied, is made with respect thereto or to the Licensed Marks or with respect to the rights of any third parties that may conflict with the rights granted herein.

5) Use and Display of Marks: Licensee acknowledges and agrees that the presentation and image of all Licensed Marks on the Marketing Materials should be uniform and consistent with respect to all services, activities and products associated with the Licensed Marks. Accordingly, Licensee agrees to use the Licensed Marks and Marketing Materials solely in the manner in which Allergan shall specify from time to time in Allergan's sole discretion. All usage by Licensee of the Licensed Marks shall include the registered trademark symbol ® or ™ as appropriate.

6) Quality Standards:

a.

Upon Allergan's request, Licensee shall furnish to Allergan, at no expense to Allergan, samples of all materials containing the Licensed Marks that Licensee currently distributes or intends to distribute. Allergan shall control the quality of all materials bearing the Licensed Marks and Licensee's use of the Licensed Marks. If Allergan believes that the Licensed Marks are being used in a manner that could diminish Allergan's rights in or protection of the Licensed Marks, Licensee agrees, at Licensee's sole cost and expense, to make whatever changes and/or corrections Allergan deems necessary to protect the Licensed Marks. Licensee shall cease using the Marketing Materials from time to time upon notice from Allergan that such Marketing Materials are outdated or should no longer be utilized.

b.

Licensee agrees that it shall not engage, participate or otherwise become involved in any activity or course of action that diminishes and/or tarnishes the image and/or reputation of Allergan or the Licensed Marks. Any use of the Marketing Materials or the Licensed Marks in connection with the advertisement or promotion of any product or service competitive to or incompatible with Allergan or the Products is not authorized.

7) Disclaimer of Warranty: ALLERGAN SPECIFICALLY DISCLAIMS ANY AND ALL WARRANTIES OF ANY KIND WITH REGARD TO ANY SUBJECT MATTER OF THIS AGREEMENT, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF NON-INFRINGEMENT OF THIRD PARTY RIGHTS, TITLE, FUNCTIONALITY, MERCHANTABILITY, OR FITNESS FOR ANY PARTICULAR PURPOSE, WHETHER EXPRESS, IMPLIED OR STATUTORY.

8) Indemnification: Licensee agrees to defend, indemnify and hold Allergan harmless from any and all costs and expenses (including reasonable attorneys' fees), liabilities, damages or other loss arising out of Licensee's negligence, improper conduct, or breach of the terms of this Agreement.

9) Limitation of Liability: REGARDLESS OF WHETHER ANY REMEDY SET FORTH HEREIN FAILS OF ITS ESSENTIAL PURPOSE OR OTHERWISE, IN NO EVENT WILL ALLERGAN BE LIABLE TO LICENSEE OR TO ANY THIRD PARTY FOR ANY LOST PROFITS, LOST DATA, INTERRUPTION OF BUSINESS, OR OTHER SPECIAL, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY KIND ARISING OUT OF THIS AGREEMENT OR THE USE OR INABILITY TO USE THE MARKETING MATERIALS OR THE LICENSED MARKS, EVEN IF ALLERGAN HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSS OR DAMAGES AND WHETHER OR NOT SUCH LOSS OR DAMAGES ARE FORESEEABLE. IN NO EVENT SHALL THE LIABILITY OF ALLERGAN EXCEED ANY AMOUNT ACTUALLY RECEIVED BY ALLERGAN FROM LICENSEE UNDER THIS AGREEMENT.

10) Termination: Allergan may terminate this Agreement in its sole discretion, at any time upon written notice. Upon termination of this Agreement, Licensee shall immediately cease to use any Marketing Materials or Licensed Marks, and as instructed by Allergan, shall immediately return all copies of any Marketing Materials to Allergan, or destroy all copies of Marketing Materials in Licensee's possession and certify to Allergan in writing that Licensee has done so. The parties hereby agree that all provisions which operate to protect the rights of Allergan shall survive and remain in force should termination occur.

11) Assignment: Licensee may not assign any of its rights or obligations under this Agreement without the prior written consent of Allergan. Any purported assignment without such consent shall be null and void.

12) Entire Agreement: This Agreement is the complete and exclusive statement of the agreement between Licensee and Allergan and supersedes any proposal or prior agreement, oral or written, and any other communications between Licensee and Allergan in relation to the subject matter of this Agreement. Any amendment or modification of this Agreement or any waiver of any breach of any term or condition of this Agreement must be in a writing signed by both parties in order to be effective and shall not be construed as a waiver of any continuing or succeeding breach of such term or condition, a waiver of the term or condition itself or a waiver of any right under this Agreement.

13) Severability: If any provision of this Agreement is deemed unenforceable, such provision will be changed and interpreted to accomplish the objectives of such provision to the greatest extent possible under applicable law and the remaining provisions will continue in full force and effect.

14) Compliance with Laws: Licensee agrees to comply with all applicable local, state, federal and international laws and, at all times, to conduct its activities under this Agreement in a lawful manner.

15) Applicable Law: This Agreement shall be governed by the laws of the State of California, USA, excluding its conflict of laws principles.

APC23UN11

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