Medical Information Request Form

Idorsia Medical Information Request Form

Please submit your medical inquiry about Idorsia’s products, trials, and research using the medical information request form below

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Product

Inquiry Text

Layout

First Name

Last Name

Professional Designation

Delivery Method

How would you like Idorsia to get back to you?

Phone

Fax

Address Line 1

Address Line 2

City

Province/State

Postal Code

Country

* I certify that I am a licensed healthcare professional and that this medical information request was not solicited in any way by Idorsia personnel. I understand that any reprint or other copyright protected materials provided to me by Idorsia may be reportable as a transfer of value under the U.S. Physician Payment Sunshine Act or applicable state transparency laws.

Idorsia retains your personal data to address or provide a reply to your medical information inquiry. In processing your personal data, Idorsia will fully comply with internationally recognized standards of data protection. In doing so, Idorsia ensures compliance of its staff with strict standards of security and confidentiality. Additional information on the processing of personal data and the exercise of rights related to your personal data can be found in Idorsia’s Privacy Policy

Medical Inquiry Request
Submit your request online

> Submit your request

MSL Request
Request a medical science liaison

> Submit your request

To report an Adverse Event
please call 1-833-400-9611

> Report an adverse event

To report a Product Quality Complaint
please call 1-833-400-9611

> Report a product complaint