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Submit a Medical Inquiry - International


This form is only for Healthcare Providers outside the US. If you are a Healthcare Professional in the US with a question about an Astellas product, please click here. Use the form below to submit your medical inquiry to our Medical Information staff. You will be contacted via your preferred contact method within 2 business days.

This form is not to be used to report potential adverse events or product complaints. To report suspected adverse events, contact Astellas at 1-800-727-7003. To report suspected product complaints, please call Astellas at 1-800-327-6449.

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Product:*
Preferred Contact Method:*
Salutation:*
First Name:*
Last Name:*
Degree:*
Institution / Practice Name:*
Address1:*
Address2:
City:*
Province/Territory:*
Postal Code:*
Country:* For Astellas US contact, please click here.
Phone:* We require a contact telephone number in case we may need to clarify your inquiry prior to providing information.
Extension:
Inquiry:*
Signature:*
By signing, I certify this is an unsolicited request for medical information.
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All personal information will be kept confidential and will not be shared with any parties other than Astellas Pharma and their designated partners. View our full Privacy Policy.


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