Disclosure Report of Switzerland - Patient Organizations 2018

I am making this request for myself or on behalf of someone else ^*

Myself

On behalf of someone else

Select request type ^*

Access Data

Correct Data

Deletion request

Limit the use of my sensitive personal information

Revoke consent

What is your relationship with Jazz Pharmaceuticals? ^*

Patient/Consumer

Health Care Professional

Contractor/Consultant

Job Applicant

Former Employee

Other: Please describe below

First Name ^*

Last Name ^*

Date of Birth – (MM/DD/YYYY)^*

Email address ^* Please use the email address you have previously provided to Jazz Pharmaceuticals

Telephone number ^*

Fax number ^*

Address ^*

City ^*

State ^*

ZIP ^*

Country ^*

Jazz Pharmaceuticals, Inc. 3170 Porter Dr., Palo Alto, California 94304

For further information please contact Jazz Pharmaceuticals’ Privacy Office at privacy@jazzpharma.com

Privacy Request Form