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Submit a Medical Inquiry - US


This form is only for US Healthcare Providers. If you are a Healthcare Provider outside 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 or the Food and Drug Administration at 1-800-FDA-1088. To report suspected product complaints, please call 1-800-327-6449.

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Product:*
Preferred Contact Method:*
Salutation:*
First Name:*
Last Name:*
Degree:*
Institution / Practice Name:*
Address1:*
Address2:
City:*
State:*
Zip:*
Country: For Astellas global 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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