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Submit Inquiry

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.

 

If you require immediate assistance, please call us at 1-800-727-7003.

 

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 US Food and Drug Administration at 1-800-FDA-1088 or www.fda.gov/medwatch. To report suspected product complaints, please call 1-800-727-7003.

*Only fields with asterisks are required.

Please fill in all required fields and check the boxes before submitting your information.

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Personal Information

*First Name

*Last Name

*Professional Designation

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*Institution/Practice Name

Contact Information

*Address Line 1

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*Zip

*Country

United States

*City

*State

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*Preferred Method of Contact

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*Email Address

*Phone Number

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*Fax Number

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Sender Email

Sender Name

*Inquiry

By submitting, I hereby consent to the collection and use of my personal information as per the Astellas privacy policy.

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Thank You

Your inquiry has been sent. A member of the Astellas Medical Information staff will contact you via your preferred contact method within 2 business days.

 

If you require immediate assistance, please call us at 1-800-727-7003.