Talking About TIA

With your permission, you will be contacted about your experience. But first, please review the Consent and Release. If you accept the terms, you will be prompted to provide your contact information.

Purpose of Consent and Release

By accepting the terms of this Consent and Release ("Consent"), you are consenting Boehringer Ingelheim Pharmaceuticals, Inc. and its affiliated entities and officers, employees, agents and other persons and entities they authorize ("BIPI") to use the information in your Testimonial (as defined below). Your Testimonial means any interviews, personal anecdotes, transcripts, quotes, images, likenesses or photographs of or by you provided by you to BIPI, in any format or medium, now known or later invented. Giving this Consent today does not mean that you are required to give consent in the future for BIPI to create or use new Testimonials.

Consent and Release

I hereby consent to allow BIPI to take, use, store, reproduce, broadcast, disclose and publish my Testimonial in presentations, publications or other public disclosures on the Internet, and any other electronic, print, broadcast, live webcast or other media for public relations, marketing and/or advertising for the purpose of assisting in raising awareness of Transient Ischemic Attack.

I agree that nothing in this Consent obligates BIPI to use or continue to use the Testimonials in any particular way, or at all. In addition, I understand, acknowledge and agree to the following:

• In any event, I acknowledge that identifying characteristics in the Testimonials could identify me.
• I waive any right to inspect, approve, disapprove, or request changes to, any of the Testimonials.
• I will make no monetary or other claim for compensation or consideration now or in the future in connection with the creation or use of the Testimonials by BIPI.
• If Testimonials are posted on a Web site by BIPI, then they might be downloaded and posted or used elsewhere without BIPI's control or permission and agree that BIPI shall have no liability for such actions.
• Copyright and all other rights to the Testimonials belong to BIPI alone unless otherwise required by applicable law.

I hereby waive and release BIPI from any and all claims related to this Consent, including, but not limited to, claims by me that any use of my Testimonial in accordance with this Consent violates my rights of privacy and/or publicity.

I am of legal age and agree to this Consent, which I have read and understood. Any questions I have about this Consent have been answered.

I will allow my name (first name) to be used

I will not allow my name to be used in connection with the use of the Testimonial

 

 

Thank you for agreeing to share your story. By speaking up and sharing your personal experience, you could help someone reduce the risk of a life-changing stroke.

Please provide your name, e-mail address and phone number, and we will contact you to talk about TIA.

Please provide your contact information.

First Name:
E-mail Address:
Phone number:
Time Zone:	PST  CST  MST  EST

Contact time preference: (Monday - Friday):

10:00 a.m. - 2:00 p.m. 3:00 p.m. - 5:00 p.m. 5:00 p.m. - 7:00 p.m.

By clicking on the button below, an e-mail will be shared with this Web site's sponsors, Boehringer Ingelheim Pharmaceuticals, Inc. and National Stroke Association. A representative from Boehringer Ingelheim will then contact you to talk about TIA.

 

To protect your privacy, your contact information will be accessible only by National Stroke Association, Boehringer Ingelheim Pharmaceuticals, Inc. its affiliates, agents and others described in the Privacy Policy. Your contact information will not be sold or forwarded to any other party for any other purpose. We appreciate your willingness to contribute your story to TalkAboutTIA.com!

You will receive an e-mail shortly explaining next steps.

As a reminder, by accepting the terms of our Consent and Release , you are consenting Boehringer Ingelheim Pharmaceuticals, Inc. and its affiliated entities and officers, employees, agents and other persons and entities they authorize to use the information in your Testimonial (as defined below). Your Testimonial means any interviews, personal anecdotes, transcripts, quotes, images, likenesses or photographs of or by you provided by you to BIPI, in any format or medium, now known or later invented. Giving this Consent today does not mean that you are required to give consent in the future for BIPI to create or use new Testimonials.

Consent and Release
I hereby consent to allow BIPI to take, use, store, reproduce, broadcast, disclose and publish my Testimonial in presentations, publications or other public disclosures on the Internet, and any other electronic, print, broadcast, live webcast or other media for public relations, marketing and/or advertising for the purpose of assisting in raising awareness of Transient Ischemic Attack.

I agree that nothing in this Consent obligates BIPI to use or continue to use the Testimonials in any particular way, or at all. In addition, I understand, acknowledge and agree to the following:

• I will choose whether my name is used in connection with the use of the Testimonial
• In any event, I acknowledge that identifying characteristics in the Testimonials could identify me.
• I waive any right to inspect, approve, disapprove, or request changes to, any of the Testimonials.
• I will make no monetary or other claim for compensation or consideration now or in the future in connection with the creation or use of the Testimonials by BIPI.
• If Testimonials are posted on a Web site by BIPI, then they might be downloaded and posted or used elsewhere without BIPI control or permission and agree that BIPI shall have no liability for such actions.
• Copyright and all other rights to the Testimonials belong to BIPI alone unless otherwise required by applicable law.

I hereby waive and release BIPI from any and all claims related to this Consent, including, but not limited to, claims by me that any use of my Testimonial in accordance with this Consent violates my rights of privacy and/or publicity.

I am of legal age and agree to this Consent, which I have read and understood. Any questions I have about this Consent have been answered.

 

 

Thank you for submitting your e-mail address and agreeing to Talk
About TIA!

By sharing your story, you could help someone reduce the risk of a life-changing stroke.

A representative from GCI Health will be in touch with you shortly to hear your story.

Warm regards,
Boehringer Ingelheim Public Relations

 

 

Thank you for your consideration. By sharing information about TIA, you could help someone reduce the risk of a life-changing stroke.

 

 

 

 

 

 

 

 

 

Language to ensure patient privacy to be incorporated here.

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