Pharm-Olam_Investigator or Site Network's Profile Survey V.1.0

Pharm-Olam International, LLC, we are a mid-size global full-service contract research organization (CRO) that conducts clinical trials with experienced investigative sites; our clients and partnerships are with both Pharmaceutical and Biotech companies. To learn more about who we are please visit our website: http://www.pharm-olam.com/about

Please take a few minutes to review our Investigator and Site Staff Privacy Notices, prior to completing this questionnaire by engaging the links below:

Click Here to Review: PHARM-OLAM INVESTIGATOR/SITE STAFF PRIVACY NOTICE

Please contact us if you are not able to access the link to our Investigator/Site Staff Privacy Notices

1.(Q1.) I acknowledge receipt and have read Pharm-Olam's Investigator and/or Site Staff Privacy Notice. I am aware, and I was informed that I may withdraw my consent at any time by sending an email to DPO@pharm-olam.com or by post at to the following address:

Pharm-Olam International

450 N. Sam Houston Parkway E.,

Suite 250

Houston, Texas 77060, USA

(Required.)

Yes, I acknowledge receipt of Pharm-Olam’s Investigator and/or Site Staff Privacy Notice and Consent to Pharm-Olam processing my data for any future possible participation in another clinical trial

YES, I acknowledge receipt of Pharm-Olam’s Investigator and/or Site Staff Privacy Notice and NO I DO NOT Consent to Pharm-Olam processing my data for any future possible participation in another clinical trial

NO, I have not received Pharm-Olam’s Investigator and/or Site Staff Privacy Notice and DO NOT Consent to Pharm-Olam processing my data for any future possible participation in another clinical trial

Pharm-Olam_Investigator or Site Network's Profile Survey V.1.0_9July 2019

Pharm-Olam International Introduction and Investigator Database Consent Information