Consent for Collection of Personal Information.
I understand and agree that my consent is required in order to collect this information. I understand and agree that I will only provide my own personal information through this form.
I agree that when I provide this information, Acadia Pharmaceuticals Inc. (“Acadia”) may collect and process this personal and/or health-related information about me and my loved one for Acadia’s COMPASS PWS study, including first and last names, contact information, and any additional personal or health-related data provided above. This information will be collected through services provided to Acadia by Merge, LLC., and may also be processed by Acadia’s data processors.
I understand that if I consent, Acadia will use this information to contact me as needed regarding the COMPASS PWS study and may disclose this information about me and my loved one to the nearest study sites to the zip code I provided that are conducting the study on behalf of Acadia.
I understand that I am not required to consent to this use and disclosure of our information, however, if I do not consent, my information will not be collected and I will not be contacted about the COMPASS PWS study and my information will not be provided to study sites.
If I consent, I have the right to withdraw consent to contact me on behalf of myself and my loved one at any time by contacting Acadia at compasspws@acadia-pharm.com.