For California Residents: By completing this form and submitting it, Chiesi USA, Inc. seeks your consent to process your personal information, including personal information related to your health condition (“sensitive personal information”) for the purposes of receiving updates about Myalept. Chiesi USA, Inc. may share your personal information and sensitive personal information with our Affiliates and Service Providers as outlined in our Privacy Policy.

You have the right to withdraw your consent at any time by submitting a request via our Privacy Center at http://privacycenter.chiesiusa.com (depending on your State of residence) or contacting us at us.privacy@chiesi.com. I understand that I may find out more about Chiesi’s privacy practices, including Chiesi’s Privacy Policy, California Notice at Collection, and Consumer Health Data Privacy Policy at www.chiesiusa.com/privacy.