Submit a Medical Inquiry


This form is only for Healthcare Providers in Colombia. If you are a patient/consumer 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. If you require immediate assistance, please call us at 01-8000-180462.

This form is not to be used to report potential adverse events or product complaints. To report suspected adverse events, contact Astellas at 01-8000-180462 or email safety-co@astellas.com.


Product:*
Preferred Contact Method:*
Salutation:*
First Name:*
Last Name:*
Institution / Practice Name:*
Address1:*
Address2:
City:*
Province/Territory:*
Postal Code:
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:*
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