Request

GE HealthCare (GEHC)
Pharmaceutical Diagnostics (PDx)
Medical Affairs
3350 N Ridge Avenue
Arlington Heights, IL 60004
Medical.Affairs@gehealthcare.com

Request to GE HealthCare Medical Affairs

This webform is intended for US Healthcare Professionals only.

To report a suspected side effect, adverse reaction, or concern about the quality of a GE HealthCare Product contact GE HealthCare PDx Pharmacovigilance at 800-654-0118 (option2, option 1) or email
Gpv.DrugSafety@gehealthcare.com. Do NOT submit on this medical inquiry form.

Please enter your contact information.

HCP Name

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HCP Email

Please enter HCP email address Please enter an email with the format username@domain

Facility/Affiliation

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Phone/Extension

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Department

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Address

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City

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Zip

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Sales Specialist Email

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Medical Affairs Request: The following must be completed using the Requestor's own words and/or with the Requestor's consent.

Describe the specific information requested

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Signature of HCP

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Signature of

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The completed form will be provided to your Medical Affairs Representative and will be included as part of GE Healthcare’s record of the healthcare provider interaction.

MedPDx-00279 August, 2024

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