Medical Information Request Form

Contact Information

*Indicates a required field

*First Name

*Last Name

Specialty

*Email

Phone Number

Fax Number

Address 1

Address 2

City

State

*ZIP Code

Country

Request Information

*Program

Delivery Method

*Inquiry Text

* By clicking "Submit," I acknowledge that I have read and accept Seagen's Privacy Policy.

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* Adverse event reported in this form should also be reported to the local Health Authority according to local legislation. For production complaints, please email productqualitycomplaints@seagen.com.

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