Medical Information Request Form (MIRF)

Please fill the form below so we can reach you with the answer

First name

Last name (required)

Title

E-mail (required)

Phone (required)

Preferred response method

Phone

E-mail

Country (required)

Country

Contact type (required)

Contact type

Contact category

HCP

Non-HCP

Internal

If you are HCP

If you are Non HCP

If you are Internal

Product Name

Please type your question (required)

By clicking the "Send request" button, you confirm your consent to the processing of the personal data as provided in the request form. Personal data will be used by Teva Pharmaceutical Industries Ltd. and its affiliates solely to provide a response to your request, and may be transferred out of your country.

For more information on how Teva processes your personal data, including information on your data protection rights, please visit our privacy policy. For a list of Teva affiliates, please visit here

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Medical Information Request Form (MIRF)

Please fill the form below so we can reach you with the answer

At Teva, we strive to deliver quality medicines to patients around the world with integrity and ethical business practices. What we do is important, but how we do it is just as important. Learn more:

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