Medical Information Form

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Personal Information

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Please enter a valid zip code

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Your email address should be in the name@example.com format

Phone number is required in case additional clarification of your question is needed.

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Contact Preferences

Our goal is to contact you within 2 business days between 9:00 AM and 5:00 PM ET Monday through Friday, except holidays. For urgent inquiries, please contact GSK Medical Information at 1-877-475-6448.

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Comments & Questions

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The information you submit will be shared with the GSK Help Center for the purpose of providing you with the services or information you requested. Please see our privacy notice for more information on how GSK handles your information.

Your Request Has Been Sent

Thank you for submitting your medical information form. We try to respond to all messages promptly. If you don’t receive a reply within 2 business days, please call us at 1-877-475-6448.