By acknowledging below, you opt-in to receiving information about GRASTEK. You represent that you are over the age of 18.
ALK-Abelló, Inc. and the third parties acting on its behalf will use your name, mailing address, and email address to send you information and related materials that you have requested in connection with GRASTEK. You acknowledge that you understand and agree that we may use your information to provide you with these updates and with other helpful information, including information that will assist you in adhering to therapy. This authorization will expire two (2) years from the date of your acknowledgement, unless applicable state law requires a sooner expiration date. You have the right to revoke this authorization at any time, except to the extent that ALK-Abelló, Inc. has taken action in reliance on it. You may revoke this authorization by notifying ALK-Abelló, Inc. in writing at the following address: Opt_out_info@alk.net. The effective date of your revocation is the date on which the revocation is received by ALK-Abelló, Inc. You understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons receiving it and it would then no longer be protected by federal privacy regulations.
Treatment, payment, enrollment, or eligibility for benefits will not be conditioned on whether you acknowledge this authorization.
You understand that ALK-Abelló, Inc. has provided financial remuneration to its contracted third parties for marketing purposes.
By acknowledging below, you wish to opt-in to receive information about GRASTEK. You are the patient/consumer, or have the patient's/consumer’s consent or the legal authority to enroll the patient for information regarding GRASTEK. You fully acknowledge and agree to the above terms and the use of your information as stated herein.
You understand that you are entitled to receive a printed or emailed copy of this acknowledgement. To receive a copy, click here to download.