2017 MEDINOL TARIFFS ORDER FORM
Your Name
*
Practice's Name
*
Phone
*
Email
*
How would like to receive the 2017 Medical Tariff Update
*
Do it for me via remote (R725)
Send link via Email (R595)
Choice of update:
*
Full: Cons+Procs+Meds+Inje+Ins
Tariffs only, NO Meds, Mat. or Inje.
Date on which your rooms re-open?
*
DD slash MM slash YYYY
Confirm
*
I am authorised to order on behalf of the practice
