Submit a Question

*Are you a Patient/Caregiver?

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Should you need immediate assistance or need to report an adverse events or product complaints, please contact 1-800-LILLY-RX (545-5979).

This form is for US residents only. To better assist in answering your question(s), please complete the following fields below:

Product*

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Question*

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Title

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First Name*

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Last Name*

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Telephone*

*By providing my mobile telephone number and submitting this form, I agree to receive automated calls about my submitted question, and I understand that no purchase is necessary to receive these calls.

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Contact by*

Telephone

Address

Address 1*

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Address 2 (Optional)

City*

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State*

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Zip/Postcode*

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Fields with asterisk (*) are mandatory

Consent Statement

Submit a Question is a resource offered by Eli Lilly & Company to respond to customer questions.

By submitting this form, I certify that I am at least 18 (eighteen) years of age or older, and I agree that Lilly may contact me, or provide information to me, in response to my submitted question, using the contact information provided above.