WINFertility is eager to provide you services per our contract with your employer NVIDIA. In this regard, it is important that WIN obtain your consent to the following questions. Per the conditions of your employer program, please note that if you do not provide your consent to the following or withdraw your consent at a later date, WIN’s ability to provide some or all services may be restricted. Please respond to the questions below and return to WINSpecialtyServices@WIN-Healthcare.com

You can click on WINFertility’s Privacy Policy to get more information on:

1. What personal information WIN obtains, stores and processes, and why

2. How WIN will use your personal information

3. Where your personal information is stored and processed

4. Who WIN will share your personal information with

5. Confidentiality and the security of your personal information

6. How you can access your information that is stored with us

7. Your rights with respect to your personal information

Data and Information Consent
Do you provide consent to WINFertility to obtain, store, process and share your personal information to the extent necessary to provide services to you?
Your conversations with WINFertility may be recorded for quality assurance purposes. Do you provide consent for storage and archival of these call recordings by WINFertility?
Do you provide consent for transfer of your personal data from your current country to WINFertility’s data centers located in the United States?
WINFertility will require verification of your age during its interactions with you for security and compliance purposes. Do you provide consent for such verification?
In relation to your personal information stored with us, you have the right to access, obtain a copy, rectify, erase, restrict, withdraw consent, or report to a Supervisory Authority. A link to our privacy policy will be sent to you further explaining these rights. Do you confirm your understanding of these rights?
You acknowledge that WIN needs to contact your physician, pharmacy or employer’s human resources department to obtain the necessary medical, pharmacy and benefit information to assist you in the program.
You acknowledge that WIN will send you an e-mail copy of your acknowledgements and consents, which act as your HIPAA disclosure consent form, if you reside in the United States. You may contact WIN at any time to change, restrict or terminate your HIPAA consents.
You acknowledge that WIN partners with the Employee Adoption & ART program (EAAP) for adoption and surrogacy support. Should you wish to consult with or have access to that program, your information will be shared with the EAAP for services.

Enter Your Name*
Date
*If you do not wish to consent to any of the above, please contact WINFertility.
NVIDIA Enrollment Application
WINFertility will email you once NVIDIA confirms your eligibility.
Employee First Name*
Employee Last Name/Surname*
Home Address*
City*
Province*
Postal Code*
Country*
Birth Date(DD/MM/YYYY)*
Telephone number include country code (home)
Telephone number include country code (mobile)*
Please enter the email address associated with your employment. We need this information to help validate your eligibility for this program. If you prefer us to use a personal email address moving forward for correspondence, please enter it below and check the box for email preference
Company Email Address*
Personal Email Address
Preferred Email Address*
Date of Hire(DD/MM/YYYY)*
Employee ID*
Program Benefit Type: To help us better serve you, please indicate below the type of service(s) you are interested in learning about for your family-building needs. If you are unsure or need to speak to a Coach please check that option below*
*
As per NVIDIA's policy requirement, is the service you are looking for available through local governmental programs and/or covered under your local NVIDIA-sponsored benefits?*
What is your rationale for requesting these services under NVIDIA's Global Family Forming program, administered through WINFertility?*
Spouse/Domestic Partner Name
Is your Spouse/Domestic Partner also a NVIDIA employee?*
Date