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Medical Information Request

This request form is provided for your convenience to submit an inquiry directly to Terumo BCT Medical Affairs department. This form is not intended to be used to report a product complaint, adverse event or to request immediate assistance with a patient treatment. No patient identifiable information should ever be included in this form.

By submitting this form, I certify that I am submitting an unsolicited request for medical information without prompting from Terumo BCT personnel.*

I confirm that I have read and agree to the Terumo BCT Terms of Use regarding the use of information.*



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