Contact Drug Information
Request Form

The site is intended for residents of Canada. For residents outside of Canada, please visit Roche Worldwide .

While Roche will make every effort to answer your inquiry and to provide the information you request, the information it provides is not intended, nor should it be used, as a substitute for informed medical advice. Any information provided should not be used to treat a health problem or disease without consulting a qualified medical practitioner. To the full extent permissible by law, any warranties expressed or implied are disclaimed as is liability for damages of any kind arising from the use of information provided, including, but not limited to, direct, indirect, incidental and consequential damages. 

Required fields are marked with *

Request Information

Product: *
Question: *
If you are reporting an adverse event or a quality complaint on a Roche product, please do not complete this form. Instead, please contact us at 1-888-762-4388.
How would you like us to reply? *

Contact Information
Salutation
First Name: *
Last Name: *
I am a: *
Institution:
Address 1:
Address 2:
City: *
Province: *
Postal Code: *
Country: *
Telephone: (Please include area code)
Fax: (Required for fax reply)
Email: (Required for e-mail reply)