Please click on one of the links below to print data collection forms:

 

The following forms require Adobe Acrobat Reader.

 

Download Acrobat Reader by Operating Systems

Here

Provided you don't know your operating system

Go here

 

OB Medical Release Form

 

Pediatric Release Form

 

Patient Information Sheet (Also known as the Patient Informed Consent)

 

Registration Form

 

Pregnancy Outcome Form

 

Pediatric Outcome Form

 

Pediatric Follow-up Status at 4-Months Form

 

Pediatric Follow-up Status at 12-Months Form

 

Breastfeeding Questionnaire

 

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Product Information

For answers to specific questions about Cymbalta, please contact Eli Lilly and Company by dialing 1-800-LillyRx (1-800-545-5979).

 

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