I understand that the information I am providing may be used by Syneos Health.

Please DO NOT report drug safety related information, including side effects, via this website.

• The information that you provide in this form (the “Form Data”) will be stored by Syneos Health . We only collect and store the Form Data you share with us so that we can provide you with a personalised response.
• We never sell the Form Data.
• We only pass the Form Data to a 3rd party with your consent or to meet legal obligations.
• We take all reasonable precautions to ensure that your data cannot be illegally accessed.

I understand that I am giving Syneos Health, who is the contract research organisation for the MOTIVATE study, and its affiliates permission to use the personal information provided in this registration form as detailed above.

Please note that in order to be enrolled in the MOTIVATE study a patient must fulfil certain inclusion criteria.

Please contact your doctor to discuss enrolment in the study. In case you have questions prior to contacting your doctor you may use this form to send your question to the coordinating investigators of the study.

Please DO NOT report safety related information, including drug side effects, via this website. If you experience any side effects, please contact your doctor.

The information that you provide will be stored and processed by the coordinating investigators. It is important that you know that:

• Data you share will be used to provide you with a personalised response.
• We never sell your personal data.
• We only pass your personal data to a 3rd party with your consent or to meet legal obligations.
• We take all reasonable precautions to ensure that your data cannot be illegally accessed.

I understand that the information I am providing may be used by the coordinating investigators to contact me regarding my question.