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What is a clinical trial report?
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Thank you for your interest in participating in one of LEO Pharma clinical trials. Please fill in the form below and click “Submit”. All fields marked with * must be filled in.
You will receive a copy of the form by e-mail once you have pressed "Submit".
First name
*
Last Name
*
Email address
*
Contact phone number
*
Town
*
Country
*
Trial number
Your message
Disclaimer
*
I understand that side effects on LEO Pharma products must be reported using the form
Public Reporting From Side Effects
May LEO Pharma share your personal data and contact information with a hospital or clinic conducting a LEO Pharma clinical trial, in order for them to contact you directly?
*
Yes
No
Data protection
*
Yes, I consent to LEO Pharma A/S' processing of personal data provided in the formula, for the purpose of accommodating my request or inquiry.
You may withdraw your consent at any time.
You can read more about our processing of your personal data in our
privacy policy
.
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