WANT TO LEARN MORE ABOUT HEP C?

If you’d like to receive additional information about hep C, complete the form below and click the “Submit” button at the bottom of this page.

TELL US ABOUT YOURSELF:
Yes, I am 18 years of age or older (You must be 18 years or older to receive information.)

*First Name:
*Last Name:
*Address 1:
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MERCK’S PRIVACY COMMITMENT

The information you provide will be available to the Merck & Co., Inc., family of companies (collectively,”Merck”) and others working on behalf of Merck, to provide the information and services you request. Personal information about you will not otherwise be disclosed for marketing purposes without your permission. Merck reviews personal information and nonidentifiable information not only to provide the requested information and services but also to develop and offer additional services and communications that we believe our customers might find of interest. Merck also may use personal information to audit its resources for compliance and security purposes. For more information about how Merck protects personal information about you, please read our Internet Privacy Policy and Privacy Commitment for US patients, consumers, and caregivers.

Your permission:

By providing your name, address, and other personal information above and clicking the “submit” button below you agree to permit Merck and others working on behalf of Merck to use this information to provide you with information and materials associated with the hepatitis C program and information resources, services and communications about hepatitis C via
E-mail or otherwise. Additionally, your information may be used for market research purposes.

At any time, you can request a copy of this permission and that personal information about you be removed from the Merck contact list for hepatitis C by calling 1-888-776-8364. Unless you change this selection sooner, your permission will expire 1 year after Merck no longer promotes products for hepatitis C.

By clicking “submit” I am signing this form:

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For more information about how Merck protects personal information about you, please read Merck’s Global Data Practices Commitment to Health Care Professionals and Internet Privacy Policy available at
www.merck.com/policy/pdf/global_data_practices_2009.pdf and www.merck.com/about/how-we-operate/privacy/internet-privacy-policy.html.