By providing your name, address, and other personal information and clicking the "Submit" button, you agree to permit Merck and others working on behalf of Merck to use this information to provide you with information, resources, services, and communications about these topics and related treatment options via e-mail or otherwise. 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 these topics and related treatment options by calling 888-776-8364. Unless you change this selection sooner, your permission will expire 1 year after Merck no longer promotes these topics and related treatment options.
By clicking "Submit," I am signing this form. I agree that my information may be used as described above.