Medical Information Request

To get more information about our products, please provide a few details and our team will contact you. Please do not use this form to report adverse events. To report an adverse event, please visit: www.gilead.com/utility/contact/report-an-adverse-event

* required field

Select a country*

Professional information*

Healthcare professional
Patient or Patient Representative

Are you submitting this from a conference?

Title

First name*

Last name*

Degree*

Institution/Affiliation

Conference Name and Location*

Gilead Representative Email

Do you require follow up from a Medical Information Scientist?*

Which product(s) are you requesting information about?
If the product is not listed, please choose "Other" and add details in description.

Select up to 3*

How would you like us to contact you?*

Email
Mail
Phone

Email address*

Street address*

Street address line 2

City*

State/Province*

Postal/Zip Code*

Country*

Phone*

By providing your information in the form above, you agree to receive communications from Gilead and its service provider(s) or partner(s) in order to respond to your request. Gilead will process the information that you provide through this and other communications to fulfill your request, for its internal business purposes, and to comply with its obligations related to safety or other legal requirements. Your personal information will be held for a limited period of time sufficient to satisfy these purposes.

Gilead may share your personal information with the relevant authorities, public bodies, or courts where required to do so by applicable law or regulation, or at their request. Where Gilead transfers your personal information outside of your country, it will be protected in a manner consistent with applicable data protection law.

For more information on how Gilead handles personal information, as well as rights you may have related to your personal information, please refer to the Gilead Privacy Statement.

Thank you, your inquiry has been submitted.