Consent to use & disclose personal information
The personal information I have provided on this form is complete and accurate to the best of my knowledge. I will update my information promptly if any of the information changes.
I have voluntarily chosen to provide this personal information, including contact information. By providing this information, I am authorizing PTC Therapeutics, Inc. and its agents and contractors (“PTC Therapeutics”) to contact me about treatments, products, and services related to the treatment of Phenylketonuria (PKU), as well as to use and disclose the information for other purposes described below, using the contact information I have provided.
I authorize PTC Therapeutics to:
- Send me information or materials related to products or services related to the treatment of PKU;
- Contact me to obtain my feedback (for market research or other purposes) about the related services offered by PTC Therapeutics;
- Use the information I have provided for market research and other data purposes, the provision of education, training, and ongoing support; and contact me as otherwise required or permitted by law.
If at any time I do not wish to be contacted by PTC Therapeutics about or to receive any information related to any product or service related to the treatment of PKU or to be contacted for any of the other purposes described above, I understand that I may unsubscribe at any time.
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