Medical Information Request | Sage Medical Hub | Sage Therapeutics

Medical Information Request Form

Contact Information

First Name:

Last Name:

NPI Number:

Professional Designation:

MD
DO
PharmD
RPh
RN
NP
Payer
Other (please specify below)

Affiliate Organization:

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Email Address:

Preferred method for receiving responses:

Preferred Date of Call Back ^*

(Hours of operation: 8:30AM - 5:00PM EST, Mon-Fri, Excluding Sage Holidays)

Preferred Time for Call Back ^*

To

Is this related to an Adverse Event?

Yes

Please call 844-4-SAGERX to report an Adverse Event

No

Inquiry Details

Medication/Compound: ^*

Other Medication: ^*

Inquiry:

I certify that this inquiry was an unsolicited request from me.

* = Required Field

THIS WEBSITE IS INTENDED FOR US HEALTH CARE PROFESSIONALS ONLY

To report an adverse event or product complaint please call 844-4-SAGERX

Medical Information
Overview

Medical Information Request Form

Request a Call
Funding & Giving
Overview

Grants

Sponsorships
Clinical Trials

Report Adverse Event

If you have an adverse event or product complaint to report, please call 844-4-SAGERX

©2020 Sage Therapeutics, Inc. All rights reserved. Home | Privacy Policy | Terms of Use | Contact Us | Site Map | Accessibility

SAGE CENTRAL, the SAGE CENTRAL logo, ZULRESSO, the ZULRESSO logo, SAGE THERAPEUTICS, and the SAGE THERAPEUTICS logo are trademarks of Sage Therapeutics, Inc. All other trademarks referenced herein are the property of their respective owners.

MRC-MDD-00033 06/20

©2020 Sage Therapeutics, Inc. All rights reserved.  

SAGE CENTRAL, the SAGE CENTRAL logo, ZULRESSO, the ZULRESSO logo, SAGE THERAPEUTICS, and the SAGE THERAPEUTICS logo are trademarks of Sage Therapeutics, Inc. All other trademarks referenced herein are the property of their respective owners.

MRC-MDD-00033 06/20