Service survey

SERVICE

SURVEY

If you would like to receive further information about SMA please complete below form providing your personal details.

Please correct the errors and send your information again.

First Name *

Last Name *

E-mail Address *

Country *

Hospital Address / Work Address *

Would you like to be contacted by a Biogen country representative to learn more abobut SMA? *

Yes

Would you like to receive email update about development in SMA? *

Yes

Data Protection Notice

By ticking this box, I confirm that I have read and understood the Data Protection Notice in its entirety and I consent to receiving business-related communication channels by email.