GMI Inquiry Form /INT/GLOBAL | PMIForm.com - Medical Inquiry Submission Site for Pfizer Inc

PLEASE REVIEW

The MI Inquiry Submission Form is for use by Pfizer colleagues to submit requests to MI.
If this is an Adverse Event, please contact your local Safety Unit.
If this is a Product Quality Complaint, please contact your local Product Quality Complaint Unit.
eFulfillment is the preferred delivery method, hard copy fulfillment will be sent via regular post mail and may result in an additional delay of 1-2 weeks for delivery.
U.S. Account Managers may only use this form to submit inquiries related to payer requests.
U.S. Account Managers should not use this form to submit a non-payer related medical inquiry.
Sales colleagues should only use this form if there isn’t an alternative system for MI enquiry submission in the country (i.e. PforceRx).

Non-medical Pfizer colleagues should direct HCPs to contact Pfizer Medical Information at https://www.pfizer.com/contact#productInquiries for any non-payer related questions.

* Denotes a required field

Medical Inquiry

Country

Product

Select Other Product if you don't see the medication you are looking for in the list.

Language

Question

Preferred Delivery Method

Date due to Customer

Customer Contact Information

Customer Type

Salutation

First Name

Last Name

Organization Name

Specialty

Address Line 1

Address Line 2

Postal Code

City

State/Region

Telephone

Fax

Customer Unique ID

Pfizer Colleague Contact Information

NT ID

Pfizer Email Address

First Name

Last Name

Role

I am not an U.S. Account Manager submitting a request for non payer related information.

I certify that this request for information concerning a Pfizer product was prompted by the customer at his or her own initiative and not at my (or any other Pfizer colleague’s) direction, prompting, or suggestion. Further, the wording of the request accurately reflects what the customer requested

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Medical Inquiry Submission Form