Thank you for your interest in Beach Pharmaceuticals. You may submit one request per product per quarter for each Health Care Professional.
Please click on the link below to download a PDF Sample Request Form. Once the form is completed, you may fax it to: 813.839.4665 or email us at firstname.lastname@example.orgDownload Sample Request Form
This form should NOT be used to report Adverse Events. To report Adverse Events, please click here.
3010 W DeLeon St
Tampa, FL 33609