Stay Connected Medical Affairs Important Safety Information Prescribing Information For Patients

Alpha-1 Antitrypsin Test Kit Request

Order an Alpha-1 Antitrypsin Test Kit

Complete the form below and a CSL representative will contact you to verify your order of the Alpha-1 Antitrypsin Test Kit.

Once your order is verified, the kit will be shipped directly to your practice free of charge.

Once you know the results, you can start your patients on augmentation therapy with confidence.

The Alpha-1 Antitrypsin Test Kits are provided to HCP offices upon request for the purpose of screening suspected Alpha-1 patients. Test kits are not for clinical trial use. Alpha-1 Antitrypsin Test Kits are provided compliments of CSL Behring and may not be billed to patients or their insurers.

*Required fields

Practice Name*

Ordering HCP, First Name*

Ordering HCP, Last Name*

Practice Address Line 1*

Practice Address Line 2

City*

State*

ZIP Code*

Phone Number*

Email Address*

Confirm Email Address*

NPI Number*

Number of tests requested*

CSL Behring respects your privacy. For an explanation of how CSL Behring will use the information you are submitting, please view our Privacy Policy.

By submitting this form, you are consenting to disclose any information provided, including your name, email address, practice address, telephone number, and any other information (collectively, “Personal Information”), to CSL Behring and its representatives, agents, and contractors, including CSL Behring’s support program(s) (collectively, “CSL Behring Entities”), and to receive communications with relevant information from CSL Behring Entities. You may also receive relevant information, including marketing information, from CSL Behring Entities by mail, email, telephone, and/or SMS/text message in the future to provide information or to offer enrollment in educational programs and programs intended to benefit patients using or eligible to use CSL Behring therapies. You will have the ability to opt out of receiving communications from CSL Behring Entities at any time.