Forms - CNS

Sign Up for Email Updates

Share your email to receive information about MEDICAL TRANSFORMED^® and new hypothyroidism resources.

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Terms and conditions

By clicking Submit, you agree to receive product and disease state information from Azurity

All personal information will be kept confidential and will not be shared with any parties other than Azurity Pharmaceuticals, Inc. and Spectrum Science Communications, Inc.

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I consent to Azurity Pharmaceuticals, Inc. collecting and storing my data from this form.^†

^†Terms and Conditions must be accepted before submission.

Learn More About MEDICAL TRANSFORMED^®

Learn more about how MEDICAL TRANSFORMED may benefit your patients.

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FIRST NAME*(Required)

LAST NAME*(Required)

EMAIL ADDRESS*(Required)

ADDRESS LINE 1*(Required)

ADDRESS LINE 2

CITY*(Required)

STATE*(Required)

ZIP CODE*(Required)

PHONE NUMBER*(Required)

Terms and conditions

By clicking Submit, you agree to receive product and disease state information from Azurity Pharmaceuticals, Inc. All personal information will be kept confidential and will not be shared with any parties other than Azurity Pharmaceuticals, Inc. and Spectrum Science Communications, Inc.

I Accept(Required)

I consent to Azurity Pharmaceuticals, Inc. collecting and storing my data from this form.^†

^†Terms and Conditions must be accepted before submission.

Subscribe to Stay Informed

To receive the latest information regarding these products, please enter your details into the fields below:

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Yes, please send me email messages from Azurity Pharmaceuticals.

To report SUSPECTED ADVERSE REACTIONS, contact Azurity Pharmaceuticals at 1-800-461-7449, or FDA at 1-800-FDA-1088 or www.fda.gov/MedWatch.

By clicking submit, you agree to disclose your personal information to Azurity and to be contacted by Azurity, its affiliates, and business partners in the future regarding products, services, and/or information related to EPRONTIA® or ZONISADE®. Azurity will not sell your information to any third party for marketing purposes without your express consent.

By clicking send, you agree to our Terms of Use and that you have read our Privacy Policy, including our Cookies Notice.

Connect With a Representative

Submit a Request to Have an Azurity Sales Representative Contact You

Whether you have a product-related question or need ordering assistance, Azurity sales representatives are here to help.

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Please note: This form is intended for US healthcare providers ONLY. By checking this box, I certify that I am a US healthcare provider.

* Denotes mandatory fields.

First Name *(Required)

Last Name *(Required)

Email Address *(Required)

Address *(Required)

City *(Required)

State *(Required)

ZIP Code *(Required)

Phone Number *(Required)

Name of Practice or Organization *(Required)

To report SUSPECTED ADVERSE REACTIONS, contact Azurity Pharmaceuticals at 1-800-461-7449, or FDA at 1-800-FDA-1088 or www.fda.gov/MedWatch.

By clicking submit, you agree to disclose your personal information to Azurity and to be contacted by Azurity, its affiliates, and business partners in the future regarding products, services, and/or information related to EPRONTIA® or ZONISADE®. Azurity will not sell your information to any third party for marketing purposes without your express consent.

By clicking send, you agree to our Terms of Use and that you have read our Privacy Policy, including our Cookies Notice.