Please print this form, fill it out and sign it.
You can either mail it to the LEO Pharma address below, email it to the US Drug Safety address or fax it to the number below.
LEO Pharma Inc.
7 Giralda Farms, 2nd floor
Madison, NJ 07940
Telephone Number: 877-494-4536 OPTION 1
Our policy only permits us to collect information from individuals 18 years of age or older. If you do not meet this criteria, please do not send us your personal information.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Click to download form (PDF).