Medical Information Request

Medical Information Request
LivaNova PLC and its affiliates (collectively “LivaNova”) has a policy against promoting, or engaging in any activity which could be interpreted as promoting our products for indications or uses not cleared or approved by local healthcare authorities. However, LivaNova recognizes its responsibility to provide accurate, balanced scientific information to licensed healthcare professionals in response to an unsolicited request for information about our products, though such requests may include information that is outside of or inconsistent with approved product labeling.

The information you provide will be used solely to address your specific request. Please do not include any patient personal data. For details about your privacy rights, please consult the privacy notice available on the LivaNova website.
Which country are you located in?
Which of the following best describes you?
NOTE: All Medical Information Requests must be signed by a healthcare professional.
Please indicate how you would like to proceed:
Your request will be sent to MedicalAffairsInternational@livanova.com
Your request will be sent to NA-US-NM-MSL-Team@livanova.com
Please pass your device to the healthcare professional so they can populate and submit their request.

Medical Information Request
(Optional) NPI Prefill
Provide your 10 digit NPI # to perform a pre-fill check
Name
Professional Credentials / Title
Email
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Telephone Number
Hospital / Organization
Address

Street Address

Street Address Line 2

CityState

Zip Code
Address

Street Address

Street Address Line 2

CityState

Postal Code
State Abbreviation
State Lookup
Please describe your specific scientific or clinical question:
By signing below, I acknowledge and affirm the following:
- I am requesting information on my own initiative.
- I understand the information provided may relate to unapproved or off-label uses of a medical device and is intended for scientific and educational purposes only.
- I understand the manufacturer does not promote off-label or unapproved uses nor provide medical advice, and will provide only balanced, scientific, non-promotional information.
- I consent to receiving scientific literature or technical documents relevant to my request.
Signature
Date

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