Form consentFOR M(oM) PROGRAM - VERIFICATION AND CONSENT INFORMATION NOTICE I agree that my Data may be Utilized by the FOR M(om) program, Helium Health, and Helium Health’s Affiliates to provide personalised support and information to me; I agree that my Data may be Utilized by Helium Health, Helium Health’s Affiliates, and Helium Health’s partners for medical research, clinical research, surveys and other forms of research or initiatives; I agree that my Data may be Utilized by Helium Health, Helium Health’s Affiliates, and Helium Health’s partners for clinical trials and studies, aimed at improving healthcare outcomes and advancing medical knowledge, amongst other objectives; I agree that my Data may be Utilized by the FOR M(oM) program, Helium Health, and Helium Health’s Affiliates for the purpose of sending me marketing or promotional communications about the FOR M(oM) program, Helium Health’s and Helium Health’s Affiliates products, services, and other offerings; I agree that my Data may be Utilized by Helium Health, Helium Health’s Affiliates, and Helium Health’s partners for purposes related to Helium Mum, Helium Health, and Helium Health’s Affiliates legitimate interests including, but not limited to: generating marketing and data-driven insights; marketing enhancement for the For M(om) program, Helium Health’s, and Helium Health’s Affiliates products; statistical purposes, market research and analytics; the overall advancement of healthcare in Africa and the rest of the world; enhancing the FOR M(oM) program; supporting Helium Health, and Helium Health’s Affiliates business interests, legitimate interests, and other interests; research purposes and surveys; supporting Helium Health, and Helium Health’s Affiliates legitimate business objectives and partnerships; the enhancement of the services we provide you.Full Name Date Submit Form