To be able to offer support, or send you educational materials, PTC, its contractors and service providers will need your address, telephone number, email address, among other contact information. Providing information is optional and may be given at your discretion. PTC may use the personal or general information obtained:
- to respond to your inquiries;
- to provide information on services you request;
- to have a representative contact you and/or your physician (if applicable) regarding our services;
- to provide updates, information, and helpful resources.
- To communicate with you and your physician (if applicable).
By providing my contact information and signing this form, I understand that I can obtain a copy of this form or withdraw my authorization at any time by emailing:
PatientEngagement@ptcbio.com
or calling:
+1-833-PTC-HOPE (+1-833-782-4673).
If I withdraw my authorization, I will no longer receive support or educational materials services as described above. PTC ensures, to the extent possible, that all personal data is processed according to all applicable privacy laws and regulations. I am providing this authorization for five (5) years or until I withdraw my authorization.
