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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*
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*
*
*
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Organization Type*
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Veterinary Clinic or Hospital
Ambulatory Practice Only
Relief Practice
Retailer
Veterinary School
Line1
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City*
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State
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AR
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ZIP Code*
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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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Yes
No
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