By sharing the details i hereby authorize the service provider & its employees to collect and process my personal information for the purpose of enabling me to participate in Glaucoma patient support program . This program is free service to patients in India who have been prescribed Latoprost RT & Synca , to help manage disease.
I hereby Authorize service provider to :
Collect personal information from me through toll free number, Link etc.
Provide education on disease condition through Web videos
Follow up with me telephonically for assistance in Glaucoma patient support program