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Express Consent Collection Statement

This site will allow you to establish a personalized account for the purpose of interacting with ViiV Healthcare regarding compassionate use of ViiV Healthcare medicines. To create a personalized account, you must provide some personal data, including your name and email address. We will use the information you submit to maintain your account, to automatically complete other forms on the Site, and otherwise as described in our Privacy Notice.

For France only: French Privacy Notice dedicated to ATU Process

By clicking the I AGREE button and/or submitting your request, you acknowledge and agree to the following terms:

• You are confirming that you have reviewed the Privacy Notice.
• You are confirming that you are a healthcare provider with a valid, current medical license.
• You are acknowledging that submission of a request for supply of product for compassionate use does not obligate ViiV Healthcare to supply product.
• You agree not to submit through this portal any information that identifies or could be used to identify a patient, including the patient’s name or initials, address, date of birth, government-issued identification number, race or ethnicity, gender, or sexual orientation.
• You agree not to submit any safety information through this portal. Any safety information, such as adverse event information, will instead be submitted using the hyperlinks or other contact information provided.
• You acknowledge that ViiV Healthcare reserves the right to correct any administrative or technology-based errors that may occur during the request or review process.

Please refer to the Privacy notice section, "How to contact us" for direct contact information.