{"id":600,"date":"2023-05-23T13:39:00","date_gmt":"2023-05-23T13:39:00","guid":{"rendered":"https:\/\/hcp.biomarin.com\/en-us\/roctavian\/?page_id=600"},"modified":"2025-01-28T11:13:22","modified_gmt":"2025-01-28T11:13:22","slug":"connect-with-us","status":"publish","type":"page","link":"https:\/\/hcp.biomarin.com\/en-us\/roctavian\/connect-with-us\/","title":{"rendered":"Connect with Us"},"content":{"rendered":"<div id=\"acf-block-64708a04467e7\" class=\"block hcp-sign-up-form block-zero-top\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                                        <h1>Connect with us<\/h1>\n<p>Interested in receiving more information, or ready to connect with a BioMarin representative about ROCTAVIAN?<\/p>\n<p>All fields marked with an * are required.<\/p>\n            \n            <div class=\"block form-box\">\n                <p>*Required fields<\/p>\n                <form id=\"hcp-sign-up\" name=\"Stay up to date\">\n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"first-name\">First name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"first-name\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your first name\">\n                        <\/div>\n\n                        <div class=\"form-item\">\n                            <label for=\"last-name\">Last name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"last-name\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your last name\">\n                        <\/div>\n                    <\/div>\n                    \n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"email\">Email<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"email\" type=\"email\" required\n                            data-pristine-required-message=\"Please enter your email address\">\n                        <\/div>\n\n                        <div class=\"form-item\">\n                            <label for=\"phone-number\">Phone<\/label>\n                            <input class=\"text\" id=\"phone-number\" type=\"text\"\n                            data-pristine-required-message=\"Please enter your phone number\"\n                            data-pristine-pattern-message=\"Please enter a valid phone number\"\n                            data-pristine-pattern=\"\/^\\(?([0-9]{3})\\)?[-. ]?([0-9]{3})[-. ]?([0-9]{4})$\/\">\n                        <\/div>\n                    <\/div>\n                    \n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"zip-code\">US postal code<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"zip-code\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your ZIP code\"\n                            data-pristine-pattern-message=\"Please enter a valid ZIP code\"\n                            data-pristine-pattern=\"\/^\\d{5}(-\\d{4})?$\/i\">\n                        <\/div>\n                        \n                        <div class=\"form-item\">\n                            <label for=\"medical-speciality\">Specialty<span class=\"required\">*<\/span><\/label>\n                            <select class=\"text\" id=\"medical-speciality\" required\n                            data-pristine-required-message=\"Please select your specialty\">\n                                <option value=\"\">Select your specialty<\/option>\n                                <option value=\"Audiology\">Audiology<\/option>\n                                <option value=\"Behavioral Neurology &amp; Neuropsychiatry\">Behavioral Neurology &amp; Neuropsychiatry<\/option>\n                                <option value=\"Cardiology\">Cardiology<\/option>\n                                <option value=\"Clinical Biochemical Genetics\">Clinical Biochemical Genetics<\/option>\n                                <option value=\"Diagnostic Radiology\">Diagnostic Radiology<\/option>\n                                <option value=\"Electroencephalography\">Electroencephalography<\/option>\n                                <option value=\"Endocrinology, Diabetes &amp; Metabolism\">Endocrinology, Diabetes &amp; Metabolism<\/option>\n                                <option value=\"ENT\/Otorhinolaryngologist\">ENT\/Otorhinolaryngologist<\/option>\n                                <option value=\"Gastroenterology\">Gastroenterology<\/option>\n                                <option value=\"General Practice\/Family\">General Practice\/Family<\/option>\n                                <option value=\"Genetics\">Genetics<\/option>\n                                <option value=\"Hearing and Speech\">Hearing and Speech<\/option>\n                                <option value=\"Internal Medicine\">Internal Medicine<\/option>\n                                <option value=\"Neonatology\">Neonatology<\/option>\n                                <option value=\"Neurology\">Neurology<\/option>\n                                <option value=\"Nutrition, Metabolic\">Nutrition, Metabolic<\/option>\n                                <option value=\"Obstetrics\">Obstetrics<\/option>\n                                <option value=\"Orthopedics\">Orthopedics<\/option>\n                                <option value=\"Pediatric Endocrinology\">Pediatric Endocrinology<\/option>\n                                <option value=\"Pediatric Endocrinology, Diabetes &amp; Metabolism\">Pediatric Endocrinology, Diabetes &amp; Metabolism<\/option>\n                                <option value=\"Pediatric ENT\">Pediatric ENT<\/option>\n                                <option value=\"Pediatric Gastroenterology\">Pediatric Gastroenterology<\/option>\n                                <option value=\"Pediatric Gastroenterology &amp; Metabolism\">Pediatric Gastroenterology &amp; Metabolism<\/option>\n                                <option value=\"Pediatric Genetics\">Pediatric Genetics<\/option>\n                                <option value=\"Pediatric Metabolism\">Pediatric Metabolism<\/option>\n                                <option value=\"Pediatric Neurology\">Pediatric Neurology<\/option>\n                                <option value=\"Pediatric Neurosurgery\">Pediatric Neurosurgery<\/option>\n                                <option value=\"Pediatric Orthopedics\">Pediatric Orthopedics<\/option>\n                                <option value=\"Pediatric Radiology\">Pediatric Radiology<\/option>\n                                <option value=\"Pediatrics\">Pediatrics<\/option>\n                                <option value=\"Primary Care\">Primary Care<\/option>\n                                <option value=\"Psychology \/ Psychiatry\">Psychology \/ Psychiatry<\/option>\n                                <option value=\"Pulmonology\">Pulmonology<\/option>\n                                <option value=\"Radiology (MRI imaging)\">Radiology (MRI imaging)<\/option>\n                                <option value=\"Research\">Research<\/option>\n                                <option value=\"Social Worker\">Social Worker<\/option>\n                                <option value=\"Surgery\">Surgery<\/option>\n                            <\/select>\n                        <\/div>                                                                     \n                    <\/div>       \n                    \n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"hospital-clinic-affiliation\">Practice name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"hospital-clinic-affiliation\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your practice name\">\n                        <\/div> \n                        \n                        <div class=\"form-item\">\n                            <label for=\"professional-designation\">Professional designation<span class=\"required\">*<\/span><\/label>\n                            <select class=\"text\" id=\"professional-designation\" required\n                            data-pristine-required-message=\"Please select your professional designation\">\n                                <option value=\"\">Select your professional designation<\/option>\n                                <option value=\"DO\">DO<\/option>\n                                <option value=\"MA\">MA<\/option>\n                                <option value=\"MD\">MD<\/option>\n                                <option value=\"NP\">NP<\/option>\n                                <option value=\"PA\">PA<\/option>\n                                <option value=\"Pharmacist\">Pharmacist<\/option>\n                                <option value=\"PhD\">PhD<\/option>\n                                <option value=\"RN\">RN<\/option>\n                                <option value=\"Other\">Other<\/option>\n                            <\/select>\n                        <\/div>  \n                    <\/div>                                                                                                                          \n\n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"rep-contact-me\" name=\"rep_contact_me\">\n                        <label for=\"rep-contact-me\">I would like to be connected with a local BioMarin representative to learn more about local events and information about ROCTAVIAN.<\/small><\/label>\n                    <\/div>\n\n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"accept-ts-cs\" name=\"accept_ts_cs\" required\n                        data-pristine-required-message=\"Please agree to the terms of use\">\n                        <label for=\"accept-ts-cs\"><strong>I agree to the Terms of Use.<\/strong><span class=\"required\">*<\/span><br>By checking this box and clicking &ldquo;Submit&rdquo; below, I confirm I am at least 18 years old; confirm I agree to BioMarin\u2019s <a href=\"https:\/\/www.biomarin.com\/data-privacy-center\/\" target=\"_blank\">Privacy Policy and CCPA Notice<\/a> and <a href=\"https:\/\/www.biomarin.com\/terms-of-use\/en-us\/\" target=\"_blank\">Terms of Use<\/a>; consent to BioMarin, its successors, agents, and\/or assignees using the email address and\/or phone number I have provided to contact me with information about ROCTAVIAN and hemophilia and keep me informed about news and developments, market research or surveys, or other opportunities that may be of interest to me; and confirm I understand these communications\/materials may contain information that markets or advertises BioMarin products, goods, or services.<\/label>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <input type=\"submit\" class=\"button\" value=\"Submit\">\n                    <\/div>\n                <\/form>\n                <form id=\"mktoForm_3470\" style=\"display:none;\"><\/form>\n            <\/div>\n\n            <div class=\"block form-success-confirmation\" style=\"display:none;\">\n                                    <h2>Thank you for registering. We&#8217;ll be in touch soon.<\/h2>\n                                            <\/div>\n        <\/div>\n    <\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-600","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Connect With Us | ROCTAVIAN\u00ae (valoctocogene roxaparvovec-rvox) for Healthcare Professionals<\/title>\n<meta name=\"description\" content=\"Connect with a BioMarin representative to have your ROCTAVIAN\u00ae (valoctocogene roxaparvovec-rvox) questions answered\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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