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This form collects your personal data (name, email address, contact telephone and address - plus any additional information you wish to share with us) for the purpose of allowing us to contact you in regards to the clinical study/studies you are expressing interest in on submission of this form. By submitting this form, you also agree to your personal information being sent via email to the Future for Patients team in order for them to contact you. You can read our Privacy Policy for more information on how we protect and manage your submitted data.
Yes, I consent to Future for Patients collecting my name, email address, contact telephone and address plus any additional information I have provided in this form submission. I also confirm that I understand that I should not disclose any medical information in this form.
I would also like to be added to your mailing list to receive email newsletters from Future for Patients.
