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Medical Information Request

To ensure a prompt response, please fully complete this form

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Your question or information request *  

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  Email        Fax        Mail

Your Personal Information

First Name *  
Last Name *  
Address *  
Address (suite, apt, etc.)  
City *  
State *  
Zip / Postal Code *  
Phone * 
Email *  

Your Professional Information

  I am a Health Care Professional

Professional Title





  I am not  a Health Care Professional

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    Please enter the word/numbers above in the "Type the text" field, then click on Submit.

    Medical Information

    Complete the form to submit a Medical Information Request or call the Corcept Medical Hotline 1-855-844-3270

    Adverse Reactions

    To report suspected adverse reactions, contact the Corcept Medical Hotline 1-855-844-3270

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