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New Product Checklist
 

*Clinic Name
*Contact Person
*Contact Number
 
*Generic Drug Name
(please ensure you get the correct spelling)
Proprietary Name
(this is the commercial brand or equivalent)
*Form
(this should be one of the forms listed below)
Quantity
(what is the approximate quantity the client requires, and please try and get an estimation of the useage)
Price
(Indicative or RRP price of commercial product)
*Is this urgent
(please indicate if this is an urgent request, i.e. supply required within a week)
Please list any ancillary information that is relevant to this enquiry
Please Select your name