We value your input. If you would like to share your healthcare experience with us, please complete the form below. Please note that, while we may not be able to work with everyone, all contributions are meaningful.

Collection of Personal Information

By submitting my information, I hereby consent to be contacted by the Patient Partnerships team. All personal information will be kept confidential and secure. Please refer to the Astellas US Privacy Policy here for information on how we handle your personal information and the choices you can make about the way your information is collected and used.

If you are a caregiver, ensure that you have permission to disclose information about the patient.

If you have any questions or would like to opt-out from use of your information, please contact: [email protected].