Data Protection Request

Please provide the information requested below to the best of your ability. We may use this information for identification and verification of your records in our systems (depending on the nature of your request). For this reason, it is recommended that you provide the contact information that we are most likely to have on file to help us confirm your identity and fulfill your request.

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This form is intended for submitting a Consumer/Data Subject Rights request under the Data Protection regulations applicable to the United States of America. It is not intended for the reporting of side effects or complaints associated with the use of any drug(s).