Health Stories Project, LLC and our affiliated companies (“HSP”, “we” or “us”) work with pharmaceutical and healthcare organizations engaged in research, advocacy, and the development of new treatments to find people who wish to share their personal health experiences. We would like to collect your information for the purposes of providing you with products and services offered by us or on behalf of our customers (“Customers”), including assessing your suitability for participation in one or more voluntary programs (each, a “Program”) provided by our customers that will involve sharing your health experiences either as a Patient or as a Carer of a patient. Health Stories Project is a limited liability company organized under the laws of the State of Washington whose legal name is HPG, LLC dba Reverba.

We take your privacy seriously. This Patient Consent Form informs you how we collect, use, and disclose your personal information for the purposes of assessing your suitability for participation in Programs provided by us or our Customers, and to communicate with you in connection with the Site, notifications, events, Programs or offerings that you may have registered for or opted in to receive via electronic communications. Please read this Patient Consent Form carefully. You are not required to sign this Patient Consent Form but you may not participate in any Program without signing it.

If you have any questions about our privacy practices, you can email us at team@healthstoriesproject.com. If you are unable to access this Patient Consent Form due to a disability or any physical or mental impairment, please contact us and we will arrange to supply you with the information you need in an accessible format. This Patient Consent Form does not govern the collection and use of your personal information by our Customers. If you are deemed eligible to participate in a Program and your information is shared with a Customer, they will handle your information in accordance with their own privacy policies and practices.

HEALTH STORIES PROJECT CONSENT FORM

By filling in and submitting this Consent Form, you confirm you have read and understand the Health Stories Project Privacy Policy and, where applicable, consent to us processing your sensitive information (or “special category data”) for the purpose of providing you with products and services offered by us or on behalf of our Customers including assessing your suitability for participation in one or more voluntary Programs offered by our Customers and sharing your information with our Customers. Your consent may be given through your authorized representative such as a legal guardian, agent, or holder of a power of attorney.

You may change your mind and withdraw your consent at any time by writing to us at team@healthstoriesproject.com. Please note that withdrawing your consent will not affect any use or disclosure of your personal information that occurred before your request has been received and processed by Us and we may still respond to any “Contact Us” requests as well as send administrative, maintenance and operational emails (for example, in connection with a password reset request).

You are not required to sign this Consent Form. It is your free choice whether or not to sign this Consent Form and your refusal to sign will not affect your relationship with Health Stories Project or any of our Customers. However, we will not be able to process your information with our Partner you may not participate in any Program connected with the signing of this Consent Form.