Request for a Medical Advisor

Please complete this form to request a meeting with an argenx Medical Advisor.

* Indicates a required field

First Name *

Last Name *

Institution

Your Profession Your Profession *

Street

City

Province Province *

Postcode *

Medical Identification Number for Canada (MINC) *

Delivery Method Preferred Delivery Method *

Phone Number

Fax Fax

For Phone contact preferred data / time for contact

Date

Time Time

Time Zone Time Zone

Product Products *

Disease State *

Inquiry *

argenx respects your privacy and the nature of the privacy relating to this inquiry. Please read the argenx Privacy Policy for additional information.

By completing this form and clicking submit, you are confirming that your inquiry is unsolicited and consenting to have your information be used to process your request. Your information will be retained within a secure environment at argenx.