Care Pharmaceuticals Sample Request Form for Health Care Professionals - RACGP Conference 2020

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* 1. Practice Name

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* 2. Title

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* 3. First Name and Surname

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* 4. Practice Postal Address

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* 5. State

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* 6. Post Code

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* 7. Telephone

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* 8. Email

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* 9. Please select "Yes" if you would like to receive relevant information on Care Pharmaceuticals Products.

Care Pharmaceuticals collects, stores, uses, discloses and otherwise handles your personal information in accordance with the Privacy Act 1988 (Cth) and as otherwise set out in Care Pharmaceutical's privacy policy available on our website at https://carepharmaceuticals.com.au/privacy-policy/

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* 10. Select "Yes" if you would like to receive a box of FREE FESS and HYDRALYTE Samples from Care Pharmaceuticals.