Consent Form

Please read the consent form so our Myeloma Information Specialists can document your request, do research for you and contact you.

You have agreed to be contacted about a request that you made to the Myeloma Canada Information Line service (MC Assistance) and requested that Myeloma Canada answer your questions. You may withdraw your consent to be contacted by us at any time by calling us at 1-888-798-5771 or e-mailing us at [email protected].

During our exchange via phone or email, Myeloma Canada will ask certain questions about your/the patient experience to determine whether the information we have in our database is responsive to your information request.

There are no conflicts of interest for us to declare related to your information request.

After this call, Myeloma Canada will send you the results of our information search in the form of an emailed research report that is based on your request. If we do not identify information that is responsive to any given portion of your request, we will note this in our report. Our hope is that you will be able to use the research report to assist you in your information search and to potentially form the basis of discussions with the patient/your doctor/other healthcare professional/family. However, nothing that we discuss on this call or provide in a report constitutes medical advice, nor is it a substitute for professional medical advice, diagnosisThe process of identifying a disease by its signs and symptoms., or treatment. All resources that we provide are for informational purposes only.

If no relevant results were identified during our initial search, and you wish to receive an update if information becomes available at a later date, Myeloma Canada will contact you again within a timeframe determined by you and Myeloma Canada at the end of this exchange via email/call.

Any information you provide us with in order to answer your questions will solely be used to facilitate our research, as well as improve our services. Some of the questions we may ask you are personal. You can choose not to answer questions if you wish.

If you decide to pursue this information request, we will only collect the information needed to answer your initial questions.

Records identifying you will be kept confidential and, to the extent permitted by the applicable laws, will not be disclosed or made publicly available, except as follows: Authorized representatives of Myeloma Canada may look at your original (identifiable) request, to check that the information collected is correct and produce statistic reports to improve our services. Additional information regarding how we collect, use, and disclose your information may be found in our Privacy Policy, which is located on our website.

Based on the description of this information request, you agree to be contacted by Myeloma Canada and consent that your information will be collected for the purpose of this request OR have the consent of the person whose information is being collected to ask questions on their behalf.

You declare that you have reviewed the terms of consent, and give consent to the continuation of this exchange via email/call. You acknowledge that all resources that Myeloma Canada provides are for informational purposes and that nothing discussed on this call or in any reports later sent to you by Myeloma Canada constitutes medical advice.

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