The information collected in this form is processed by MEDIPHA SANTE, the data controller, in order to respond to your request. This processing is based on MEDIPHA SANTE's legitimate interest in processing and following up on requests submitted to it. Fields marked with an asterisk are mandatory.
Otherwise, MEDIPHA SANTE will be unable to process your request. The data is intended for authorized MEDIPHA SANTE departments and its service providers involved in the technical management of the website, within the limits of their responsibilities. It is kept for the time necessary to process the request, then archived in accordance with applicable legal retention periods.
In accordance with applicable regulations, you have the right to access, rectify, erase, restrict, and object to the processing of your personal data. You can exercise these rights by contacting: [email address of the Data Protection Officer or the GDPR contact], or by mail to MEDIPHA SANTE, Les Fjords, 19 avenue de Norvège, 91140 Villebon-sur-Yvette, France. You can also lodge a complaint with the French Data Protection Authority (CNIL).
For more information, please see our [Personal Data Protection Policy].