2018 MEDINOL TARIFFS ORDER FORM
Your Name
*
Practice's Name
*
Phone
*
Email
*
How would like to receive the 2018 Medical Tariff Update
*
Do it for me via remote (R795)
Send link via Email (R720)
Choice of update:
*
Full: Cons+Procs+Meds+Inje+Ins
Tariffs only, NO Meds, Mat. or Inje.
Date on which your practice will be ready for the update?
*
DD slash MM slash YYYY
Confirm
*
I am authorised to order on behalf of the practice
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