CONSENT: I agree to be enroled in the EasyFIV™ programme. I understand that my enrolment is by choice and that I am free to withdraw at any time, without giving any reason, without my medical care or legal rights being affected. I understand that the information gathered about me may include medical information relating to my involvement in the programme. I am aware that my personal information will be securely stored by Human Care Systems on behalf of MAIA. Human Care Systems operates the EasyFIV™ programme on behalf of MAIA, and Teva Pharmaceuticals funds the programme. I agree that Human Care Systems may only share anonymised data that has been combined with other programme participants with MAIA and Teva affiliates. I am aware that this anonymous combined data may be used to administer and evaluate the results of the programme and may be published. I also agree that some of my personal and identifiable information may be shared with my clinicians for them to report IFV outcomes to the Agence De La Biomedecine as per legal requirement.