This webform is intended for Health Care Professionals only.

Complete all Medical Information Request Form fields entirely and include only one requestor per request.

This form should not be used to report Adverse Events (AE) or Product Quality Complaints (PQC).

To report an AE, contact the safety department at 800-734-9236 or click here.

To report a PQC, contact the quality department at 888-354-4859.

For medical information during normal business hours (9:00 am – 5:00 pm Eastern Time, Monday – Friday), please call 888-354-4855. For medical information outside of normal business hours that cannot wait until the next business day, please call 1.877.845.6371


By clicking Submit, you confirm that you accept our Privacy Policy and that you agree to your personal contact information being used to contact you and added to our database. If at any time you wish your personal information to be removed from the American Regent database, please submit a message request to