High demand products

We have identified this as a ‘high demand’ product and are attempting to secure a reliable source of supply. In the meantime, please complete the form below and be assured that your request will be treated as a priority.

Forms should only be completed by healthcare professionals. If you are a patient or a relative / friend of a patient please contact your local healthcare professional for advice.

Fields marked * are mandatory.

Contact details

First name *

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Surname *

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Email *

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Phone *

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Your organisation

Organisation name *

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Address 1 *

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Address 2

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City *

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Postcode *

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Organisation Country *

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Your drug request

Generic name/Active Ingredient *

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Brand name

Strength *

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Pack Size

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Dosage Form *

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Presentation

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Required Quantity *

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Required Target Price

Preferred Language

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Drug authorisation

Does this product have a Marketing Authorisation in your country?

Yes but is on short supply

Yes but is not being commercialised by its holder

Yes but is going to be discontinued

Yes but I need a specific dose form

Is this a controlled drug in your country?

Yes

Do you have permission from the health authorities in your country to import this product in compliance with local regulations?

Yes

* Are there any compulsory documents you need to be provided in order to import this product into your country?

This field is required.

Which territories are you willing to accept products from?

EEA and Mutual Recognition countries (Australia, Canada, Israel, Japan, New Zealand, Switzerland)

USA

Third countries

* Is this product for a patient with a clinical need which cannot be met by a licensed product in your country?

Yes

This field is required.

* Please select from the below

I am a healthcare professional

I am a patient or relative of a patient

This field is required.

Is there anything else we should be aware of or that might help us find your medicine faster?

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