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Have you been diagnosed with NTM lung disease?*

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First Name*

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Last Name*

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Email*

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Mailing Address*

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Apartment, suite, etc.

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I am over 18 years of age and consent to Insmed collecting and processing my Health Information as described below.*

I agree that Insmed may collect, use, and process my Health Information, as listed below, to provide information, resources, support, and other communications about nontuberculous mycobacteria (NTM), management approaches and medications related to NTM, and management approaches for related lung conditions such as bronchiectasis:

• Health conditions, treatments, diseases, or diagnosis;
• Social, psychological, behavioral, and medical approaches to managing health;
• Health-related surgeries or procedures;
• Use or purchase of prescribed medications;
• Health measurements, including vital signs, symptoms, and bodily functions;
• Diagnoses or diagnostic testing;
• Data that identify me as a consumer seeking health care services; and
• Health-related data that have been derived or inferred from the above (collectively “Health Information”).

I understand that I am not required to consent to collection and processing of my Health Information for these purposes. However, if I do not consent, I will not be able to sign up, as collection and processing of my Health Information is necessary for Insmed to provide these services to me.