Request CSL Employee Medical Information

United States CSL Employees Medical Information Request Form

If you are not a US CSL Employee please select the correct option to submit your request

US HCPs

I certify that I am submitting this question on behalf of a healthcare professional who reactively asked a medical information question. And they understand that the information provided to them will be used by CSL Behring and/or its contracted third parties to contact them with relevant information.

Medical Information Request

Name of CSL Employee submitting MIRF on behalf of HCP

Check this box if the inquiry was received during a conference?

Name of Conference

CSL Behring Product

Describe the Request

HCP Name

Professional Credentials

Contact Information

How would the HCP like to hear from us?

Phone Number

HCP may also request contact from a Medical Science Liason (MSL)

Yes, the HCP would like to be contacted by an MSL

Healthcare Professional Information

Institution Name

Institution Address 1

Institution Address 2 (optional)

City

State

Zip Code

By selecting "Submit" on this form, you are consenting to disclose any information provided, including your name, email address, professional license number, and any other information (collectively "Personal Information") to CSL Behring and its representatives, agents, and contractors (collectively "CSL Behring Entities") and to receive communications with relevant information from CSL Behring Entities. You will have the ability to opt out from receiving communications from CSL Behring Entities at any time. CSL Behring and CSL Entities will not sell your personal information.

CSL Behring respects your privacy. For an explanation of how CSL Behring will use the information you are submitting, please view our CSL privacy notice for medical information enquiries: https://privacy.csl.com/pv-medinfo-pqc.

Thank you for requesting medical information

We strive to answer all questions in a timely manner, and most questions will be answered within 2 business days. Questions requiring additional research may take up to 2 weeks.

You may also contact us via phone at 1-800-504-5434, via e-mail at MedInfoNA@cslbehring.com or via live chat at https://medicalaffairs.cslbehring.com/

CSL Behring Medical Information
1020 First Avenue
King of Prussia, PA 19406
Phone: 800-504-5434
Fax: 610-878-4550
Email: MedInfoNA@cslbehring.com