Medical form

Information intended for the medical community

in accordance with Regulation 648/2004/CE, we will on request provide you with a medical data sheet on our products. The information presented on this sheet must be treated confidentially by medical staff and can be used only for medical purposes..
For a correct record and processing of your request, please print this form page and return it to us by fax or by post.

Pharmacos provides a table of correspondence between the INCI names of the ingredients, their CAS numbers and their names proposed by the European Pharmacopeia.

Identification of the Requester :





Identification of the Product :

Purpose of the Request :

Declares on his or her honour that the transmitted information will be used for medical purposes only.