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This form is for U.S. healthcare providers only. For product inquiries outside the United States, contact your local Allergan Office
to report a suspected adverse event. DO NOT report adverse events on this form.
For patients/caregivers, please consult with your physician or contact the Medical Information department
Please tell us what information you are requesting, being as specific as possible. If you have additional questions on other products, please submit another request form.
If the product of interest is not present, please contact our medical information department.
Your signature confirms your question(s) was (were) not prompted or solicited by anyone at Allergan and that the wording above accurately states your question(s).