Medical Information Request

If you have a medical inquiry around the clinical use of a Promega product, please complete the form below and a Medical Affairs representative will be in touch with you shortly.

MS-2020-Medical Affairs-Information Request
Promega product of interest:
I am interested in submitting an unsolicited inquiry to Medical Affairs regarding the following:*
How would you best describe yourself?
First Name*
Last Name*
I have read and agree to the Promega Guidelines for Processing Personal Information (see link below)*
This form is for the documentation and transmission of unsolicited medical inquiries to Promega Corporation Medical Information. 
I certify that I am the requestor; I have requested the information described above and I confirm that this inquiry was not solicited in any manner by a representative.

This form should not be used to report a product complaint or adverse event. Complaints and adverse events should be reported to Technical Support at Promega. Find local contact information here