Visitor Information Form

Personal Information


Emergency Contact

Medical Insurance

In consideration of Hagyard Davidson McGee Associates, PLLC (“Company”) training me and for other good and valuable consideration, I agree to the following:

1. Definitions. As used in this Agreement, the term “Client(s)” is defined as any person, company, board or other entity from whom the Company has obtained compensation, either directly or indirectly, or provided professional services to at any time during my training with the Company. The term “Prospective Client(s)” is defined in this Agreement as any person, company, board or other entity from whom the Company has attempted to obtain compensation, either directly or indirectly, or attempted to provide professional services to at any time during my training with the Company.

2. Confidentiality. I acknowledge and agree that during the course of my training with the Company, I will have access to and will learn confidential, proprietary, and trade secret information of the Company. Such information includes, but is not limited to all of the following: the identity and addresses and phone numbers of the Company’s Clients or Prospective Clients; information about the Clients’ or Prospective Clients’ businesses (including but not limited to services, financial records, proprietary process, technical information and know-how, intellectual properties, management policies, economic policies, marketing plans, customer lists, computer software, personnel, methods, practices, processes, systems, business plans, marketing techniques, selling techniques, prices, legal issues, public relations issues, and advertising plans, projects, programs and related matters) and other confidential information of the Company’s Clients or Prospective Clients; and the Company’s services, financial records, proprietary process, technical information and know-how, intellectual properties, management policies, economic policies, marketing plans, customer lists, computer software, personnel, methods, practices, processes, systems, business plans, marketing techniques, sales techniques, prices, legal issues, public relations issues, advertising plans, projects, programs and related matters, and accounts receivable lists; or any other confidential business information related to the Company’s business operations or to the business operations of HDM Pharmacy LLC. All such information as described in this paragraph shall hereinafter be referred to as “Confidential Information.”

I acknowledge and agree that all Confidential Information obtained and/or learned by me during my training by the Company is valuable, special or unique property of the Company. I further acknowledge and agree that my knowledge of or access to Confidential Information is provided for the sole purpose of my training with the Company, and to provide services to the Company and/or its Clients and to conduct business activities on behalf of the Company. I agree that I will not use Confidential Information or divulge, disclose, or communicate Confidential Information in any way to any person or entity, except as authorized by the Company.

3. Ideas and Creations. All intellectual property, creative work, artwork, presentations, drawings, sketches, writings, photographs, ideas, concepts and other property which I may conceive, develop or procure in connection with my services for the Company or the Company’s Clients, including all materials incorporated therein and all preliminary or other copies thereof, whether such materials were conceived or created by me individually or jointly, on or off the premises of the Company or during and after training time, shall be “works made for hire,” with all rights therein, including copyright, being the Company’s property or the property of the Company’s Clients and such rights include the exclusive right to own and register the copyright in the Company’s name or Company’s Client’s name. In the event that any such material is considered not to be a work-made-for-hire, I hereby assign to the Company all right, title and interest in such work.

4. Property. I shall not remove from the offices of the Company any materials containing any Confidential Information except as necessary to the performance of my responsibilities on behalf of the Company or its Clients. In the event of any such removal, I shall return all such materials to their appropriate place as soon as possible following their removal. I shall not make, retain or distribute any copies of any such materials for any reason except as authorized and necessary for the performance of my responsibilities.

Upon the completion of my training with the Company, I shall promptly deliver to the Company’s designated representative all Confidential Information and other documents, records, work-made-for-hire, client lists, or notebooks (including information that is stored electronically) that relate to the business activities of the Company and all material or property (including copies) that belongs to the Company or its Clients.

5. Governing Law, Forum. I agree that the validity, construction or effect of this Agreement shall be governed by the laws of Kentucky, regardless of any otherwise applicable choice of law provisions. I and the Company agree that any disputes between us shall take place in the state or federal courts located in Fayette County, Kentucky.

6. Attorneys’ Fees. In the event that I am found by a court to have materially breached this Agreement, then I shall pay the Company’s reasonable attorneys’ fees and costs.

7. Assignability. I agree that this Agreement shall inure to the benefit of any successors and assigns of the Company and that I cannot assign to any other person the obligations that this Agreement places on me.

I agree that the restrictions set forth in this Agreement are essential to the business of the Company and its Clients and any violation of these restrictions may irreparably damage the Company and its Clients. Consequently, I agree that, in addition to all the rights and remedies the Company or its Clients shall have, the Company and its Clients shall have the right to obtain an injunction from any court of competent jurisdiction without posting a bond enjoining the breach of any of the restrictions set forth in this Agreement.


By checking the accept box below I acknowledge that I understand this Confidential Information Policy and will fully comply with the letter and spirit of it.