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Privacy Request Form

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This page is intended for U.S. residents only. We are not accepting requests from individuals in states other than California, Washington and Nevada. If you are not a resident of any of these states, please do NOT continue.

Please select and enter the required fields on the form below. We need this information to process your request and to take necessary steps to verify your identity. We will contact you if we need any additional information.

Please note that your rights may vary under applicable state privacy laws and may be subject to limitations.

I am making this request for myself or on behalf of someone else ^*

Myself

On behalf of someone else

Select request type ^*

Access Data

Correct Data

Deletion request

Limit the use of my sensitive personal information

Revoke consent

What is your relationship with Jazz Pharmaceuticals? ^*

Patient/Consumer

Health Care Professional

Contractor/Consultant

Job Applicant

Former Employee

Other: Please describe below

Select Jazz Pharmaceuticals Product(s)^*

Epidiolex® (cannabidiol)

Xyrem® (sodium oxybate)

Xywav™ (calcium, magnesium, potassium and sodium oxybates)

Defitelio® (defibrotide sodium)

Rylaze™ (asparaginase erwinia chrysanthemi (recombinant)-rywn)

Vyxeos® (daunorubicin and cytarabine)

Zepzelca™ (lurbinectedin)

First Name ^*

Last Name ^*

Date of Birth – (MM/DD/YYYY)^*

Email address ^*

Please use the email address you have previously provided to Jazz Pharmaceuticals

Telephone Number ^*

Fax number ^*

Address ^*

City ^*

State ^*

ZIP ^*

Country ^*

Jazz Pharmaceuticals, Inc. 3170 Porter Dr., Palo Alto, California 94304

https://www.jazzpharma.com/privacy-statement/

For further information please contact Jazz Pharmaceuticals’ Privacy Office at privacy@jazzpharma.com