If you wish to report an adverse event or product complaint, please call 1-800-LILLYRX (1-800-545-5979)

Sample/Sales Representative Request

Medical professionals can submit a request to Eli Lilly and Company for medical information, samples and sales representative visits.

What is this request for? *

Sample

Sales Rep Visit

Both

Product *

Type of HCP *

HCP Speciality *

Title

Prescriber First Name *

Prescriber Last Name *

Phone *

Office Contact First And Last Name *

Office Street Address *

City *

State *

Zip Code *

Fields with (*) are mandatory

Contact Lilly

If you need information about a Lilly product or want to report an Adverse Event or Product Complaint, you may call us.

Available Mon - Fri, 9am - 8pm ET