I agree that I have read this Consent Form and by providing my personal and health information and clicking “SUBMIT,” I understand and agree that Sanofi U.S., its collaborators, including Regeneron Pharmaceuticals, Inc., its affiliates, and its agents (third parties working with, or on behalf of, Sanofi U.S.) (together “Sanofi”) may use my personal and health information to provide me services, which may include medication and adherence communications and support, medication dispensing support, coverage and financial assistance support, disease and medication education, injection training and other support services. I authorize Sanofi U.S. to contact me by periodic or recurring mail, telephone, or email communications, or, if I indicate my agreement and consent above, by text communications, to provide assistance and additional support, and to provide me with information about the services, hypercholesterolemia and products, promotions, other services and to ask my opinion about such information and topics, including through market research and disease-related surveys. I further authorize Sanofi U.S. to de-identify my health information and use it in performing research, education, business analytics, marketing studies or for other commercial purposes. I understand that Sanofi may share my identifiable health information with one another in order to de-identify it for these purposes and as needed to perform the services and the other listed activities, or to send the communications described above. I understand that Sanofi 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 I may be contacted by Sanofi in the event I report an adverse event.
I understand that I do not have to consent, enroll or receive communications as a condition of purchasing any goods or services, including medications, but I won’t be able to receive the services and communications described above if I don’t consent. I also understand that if I do not want my information used for the purposes described above, I can close this window and discontinue my registration. I also understand that I can opt-out of continued communications from Sanofi U.S. at any time by visiting , by calling 1-800-633-1610, or by sending a letter to Sanofi U.S. Customer Service, 55 Corporate Drive, P.O. Box 5925 Mailstop 55A-220A, Bridgewater, NJ 08807. I also understand that the services, activities and communications may be revised, changed or terminated at any time.
I confirm that I am the authorized user for the telephone and email address provided above and I agree to notify Sanofi promptly if the mail or email addresses or telephone numbers change in the future.