Online Consent Form

Dear Healthcare Professional,

Roche (Philippines) Inc. (“Roche”) is committed to deliver innovative pharmaceutical products and related services to healthcare professionals and to the community.

In order to provide you with better and personalized service, we would like to collect some of your personal information such as your name and contact details ("Your Data").

We would therefore be grateful if you would please complete your details and confirm your agreement to your data being managed in accordance with our Privacy Policy and Philippines' Republic Act No. 10173 or the "Data Privacy Act of 2012" and for the purposes specified above.