Please complete the form below to contact a Terumo BCT representative and request more information.
First Name *
Last Name *
Email Address *
Title *
Company Name/Hospital *
Phone
Country * Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia Herzegovina Brazil Brunei Bulgaria Cambodia Canada Chile China Colombia Costa Rica Cote d'lvoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Republic Dutch Antilles Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Finland France French Guiana Georgia Germany Greece Guatemala Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Laos Latvia Lebanon Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Malaysia Maldives Malta Mauritius Mexico Moldova Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Nigeria Norway Oman Pakistan Palestine Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Saudi Arabia Serbia Seychelles Singapore Slovakia Slovenia South Africa Spain Sri Lanka Sudan Sweden Switzerland Syria Taiwan Thailand Togo Trinidad and Tobago Tunisia Turkey UAE Ukraine United Kingdom United States Uruguay Uzbekistan Vatican City Venezuela Vietnam Yemen
How many MG patients do you treat per year? Select Less than 5 5-10 11-20 Over 20
Do you prescribe plasma exchange for your neuromuscular patients? Select Yes No
What are your treatment challenges with neuromuscular patients? (Select all that apply): Treatment costs Patient safety Convenience of therapy Time until patient’s response to treatment (time it takes to get an accurate diagnosis for a patient) Time of patient’s recovery (determining which treatment option will most quickly stabilize the patient so recovery can begin)
Questions/Comments:
* I confirm that I have read and agree to the Terumo BCT Privacy Policy.
Yes, I would like to receive future communications about Terumo BCT.
Prospect Source
Prospect Source (Most Recent Touch)
Prospect Source (First Touch)
Last SFDC Campaign ID
Lead Source Original
Product Family
Business
Status