Medical Information Request

Healthcare Provider Request For Medical Information

This form is intended for US healthcare providers only. This form is sent to a general mailbox and there may be a delay in receipt or response. Please do not include any medical or patient related information.

For patients/caregivers, please consult with your healthcare provider. If you are a patient who wishes to speak with someone from Cytokinetics, you may contact Cytokinetics Medical Information at [email protected] or call 833-MEDCYTO (833-633-2986).

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Title

First Name

Last Name

Professional Designation

Phone Number

Email Address

Institution/Office

Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred method of response

Please provide your specific question or request for information (max 300 characters). Do not include any patient identifiable information.

Info Confirmation

By submitting this medical information request, I certify that I am a healthcare professional and confirm that the information requested was unsolicited and is intended for educational purposes only. *

I acknowledge that I have reviewed Cytokinetics' Privacy Policy. *

Cytokinetics adheres to the U.S. PhRMA Code and other Industry guidelines and standards. As such, receipt of certain medical information materials (such as reprints) may constitute reportable transfers of value for covered recipients.

The information you provide will be handled in accordance with our privacy policy.

* = Required Field