RADICAVA (edaravone)

I agree that I have read this Consent Form and by providing my personal information and clicking SIGN UP FOR UPDATES I understand and agree that Mitsubishi Tanabe Pharma America, Inc. (MTPA), as well as its collaborators, affiliates, and agents (third parties working with, or on behalf of, MTPA) (together, the MTPA Parties), may use my personal information to: send me periodic or recurring communications that provide information and/or materials related to disease state, products, promotions, services, and research studies; ask my opinion about such information and topics, including performing market research and disease-related surveys; contact me about other products and services offered by MTPA; share my personal information with one another to perform these activities; and de-identify it for use in performing research, education, business analytics, marketing studies, and other commercial products.

I also understand that the MTPA Parties may combine my personal information with information about me from third parties to better match the communications or materials with my interests.

I understand that my consent or enrollment is not required as a condition of purchasing any goods or services, including medications, but I wont be able to receive marketing and/or promotional communications if I do not consent.

I understand that, depending on the type of contact information I provide, the MTPA Parties may contact me by mail, email, phone calls, voice messages, interactive voice recordings that may include use of autodialers or artificial or prerecorded voice messages, and SMS text messages (data rates may apply).

I understand that I may be contacted by the MTPA Parties in the event I report an adverse event.

I agree that the MTPA Parties may use my personal information, which includes my personal health information, to send me periodic or recurring reminders or other information about my medication.

I understand that if I do not want my information used for the purposes described above, I can discontinue my registration. I also understand that if I register, my consent will be effective until I opt-out of receiving the relevant marketing communications. Marketing communications will include information about how I can opt-out of receiving future communications. I understand that my participation in the Searchlight Support Program will not be affected if I opt-out.

I confirm that I have reviewed the MTPA Terms of Use and Privacy Policy and I understand that MTPA may change its Terms of Use or Privacy Policy from time to time.

I confirm that I am the authorized user for the email address and/or phone number provided above.

I understand that MTPA will not sell or transfer my personally identifiable information to any party for the other partys own marketing use.

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RADICAVA (edaravone)