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First Name
Last Name
Email Address
Phone*
Title*
Veterinary Practice Owner
Veterinarian Associate
Academic or Faculty Veterinarian
Relief Veterinarian
Veterinary Student
Other
Organization Name*
Organization Type*
Veterinary Clinic or Hospital
Ambulatory Practice Only
Relief Practice
Retailer
Veterinary School
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City*
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Do you currently prescribe Adequan
®
i.m.?
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No
Do you currently use BetaVet
®
?
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