Medical Information Request

This form is for U.S. healthcare providers only.

Contact Allergan to report a suspected adverse event at 1-800-678-1605.
DO NOT report adverse events on this form.

For patients/caregivers, please consult with your physician or contact our 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.

The information you provide will be treated in accordance with Allergan's Privacy Policy.

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).