DSASignUpForm-RA-Fullsite-2020

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[Hidden]Origin Name

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First Name

Last Name

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Email Address

We ask for your email address so we can send you information about RA.

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ZIP Code

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Date of Birth

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We ask for your DOB to ensure you’re over 18 and to help us recognize your registration record.

DateOfBirth is required

Gender

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When were you diagnosed with RA?

Not diagnosed

The past 0-2 years

The past 2-5 years

5 years ago or more

Diagnosis is a confirmation of disease made by your doctor.

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The symbol ® indicates that the trademark is registered in the U.S. Patent and Trademark Office and certain other countries. All names and trademarks mentioned are the trade names, trademarks or service marks of their respective owners.

How well do you feel that your RA is being managed?

It's great!

It's okay

I need better

Not applicable

[Hidden]QuestionId4

I’d like to receive a free RA Wellness Handbook—an all-in-one resource with recipes, RA management tips, symptom tracking, and more to help you live better with RA.

Street Address*

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City*

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By submitting this form, I consent to the collection, use, and disclosure of my health-related personal data and/or precise geolocation personal data to receive communications from AbbVie regarding its products, programs, services, clinical trials, research opportunities and for online targeted advertising, as further described in the “How we may use Personal Data,” “How we disclose Personal Data,” and “Cookies and similar tracking and data collection technologies” sections of our Privacy Notice. My consent is required to process sensitive personal data under certain privacy laws, and I have the right to withdraw my consent by visiting “Your Privacy Choices” on AbbVie’s website.

AbbVie may collect your personal data through your online and offline interactions with us, including your contact, demographic, and health-related data...

...We may also collect your online usage data automatically through cookies and similar technologies. We use this information for several purposes, such as to provide you with, administer, and improve our programs, services and products, customize your experiences, and for research and analytics. We retain your personal data for as long as necessary to fulfill these purposes or to comply with our record retention obligations. We do not sell your personal data, but may use and disclose your personal data with marketing and advertising partners to deliver you ads based on your interests inferred from your activity across other unaffiliated sites and services (“online targeted advertising”) and for website analytics. To opt out of the use or disclosure of your personal data for online targeted advertising or for website analytics, go to Your Privacy Choices on our website. For more information on the personal data categories we collect, the purposes for their collection, disclosures to third parties, and data retention, visit our Privacy Notice.

Through my submission of the Rheum for More Information Sign-up Form, I consent to the collection, use, and disclosure of my personal health data, as described in the Privacy Notice above and in AbbVie’s Privacy Notice in the “How We May Disclose Personal Data” section. My consent is required to process sensitive personal data under certain privacy laws, and I have the right to withdraw my consent by visiting “Your Privacy Choices” on AbbVie’s website.