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Request for VEOZATM 45mg Starter Pack(s)

(10 film coated tablets)

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By filling & submitting this form, you will be able to place a request for our Veoza Starter Pack(s) for your practice purposes that will be delivered to your registered address when approved.

Astellas provides medicines and support for doctors treating patients across a range of therapeutic areas. We have healthcare, medical and scientific-related information and materials that we believe may be relevant to your practice.

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VEOZATM 45mg Starter Pack(s) (10 film coated tablets)

Terms and Conditions

I have read and agree to the Terms of Use and Privacy Policy. I also acknowledge that the information collected on this form is confidential and will only be used exclusively for the purpose of processing and fulfilling the requested starter pack order. Astellas does not share or use this data for any other purposes.

Consent

I hereby declare that I am a licensed healthcare professional & I am the person named above. I affirm that these samples are being requested for professional use only and will not be sold or otherwise distributed outside of my medical practice. I understand that the provision of these samples is subject to applicable laws and regulations governing pharmaceutical samples and that any misuse of these samples may result in legal consequences. By placing this starter pack request, I confirm that I will adhere to all relevant policies and guidelines regarding the handling, storage, and administration of the samples provided.

Please note that there is a limit of three starter packs per month, which will be verified during the order fulfillment process.

Thank you for your request.

Your request has been submitted. We will review the request & let you know the next steps once reviewed.