REPORT A PREGNANCY

By selecting 'I confirm' I agree with the statements below

I Confirm
I am 18 years of age or older *
I agree to the statements below and have read and accept the Privacy Policy *

*Note: You understand and consent that any information you choose to provide will only be used by the Pregnancy Study Coordinating Center to contact you and will not be shared for any other purpose with any other third-party recipients.

Regarding the contact details provided in this form and the processing of provided data, we will only contact you based on your preferred contact method of contact selected above. By submitting this form (when clicking the submit button below), you understand that your preferred method of contact selection provides your consent for us to contact you in addition to allowing us to collect your personal information that you provide to us when submitting this form. You may opt-out at any time by contacting us at Yorvipathpregnancy@ubc.com. Please visit our Privacy Policy for information about how you may opt-out of further communications from us or wish to exercise any other privacy rights available to you. Our Privacy Policy also provides you with information about the processing of your personal information.

By submitting this form you agree to our Terms of Use and Privacy Policy.

After you submit your information, a representative from the Pregnancy Study Coordinating Center will contact you via your preferred method within 1 business day.

Thank you for completing this form. By providing your contact information, you are giving permission for the Study Coordinating Center to contact you to share more information about the study. This permission to be contacted does not mean you are agreeing to take part in the study. Participation is completely voluntary.

To report a pregnancy over the telephone, you may contact the
Pregnancy Study Coordinating Center at 1-877-229-2184
8:00am - 8:00pm M-F Eastern Time.