Thank you for your interest in receiving a donation from Pfizer.
A member of our team will be in touch with you shortly.
Upon submission, Pfizer will undertake an assessment of your request and respond to you in a timely manner.
Note: This form is for donations we are currently making available to healthcare, medical and scientific associations and organisations in the UK. To contact Pfizer for any other purpose, including reporting of adverse events, medical information requests or data protection enquiries, please call 01304 616161. Note that any adverse events reported to Pfizer should also be reported to the MHRA. See https://yellowcard.mhra.gov.uk for further information.
* Required fields
Requestor's Information
Full Name*
Contact email address*
Contact telephone number*
Organisation Information
Name of healthcare organisation that will be the recipient of the donation*
Address line 1*
Address line 2
City*
Postcode*
Donation Information
If you have discussed potential delivery of the selected project with a Pfizer Account Manager, please enter the Account Manager's name.
What is the proposed start date of the project?*
What is the proposed end date of the project?*
By clicking the Submit button below, you confirm your agreement to (i) Pfizer’s processing of your personal data, including its international transfer, in accordance with the Pfizer Cookie Policy and Privacy Policy; and (ii) Pfizer’s Website Terms of Use.
Please note that submitting your request for a donation does not constitute a guarantee of support. Donations are awarded on a ‘first come, first served’ basis, subject to availability and any stated criteria.