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How to fill out the Samples online
Filling out the Samples request form is a straightforward process that allows you to obtain complimentary samples of ® . This guide provides step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to complete your Samples request form.
- Click the ‘Get Form’ button to retrieve the Samples request form and open it for editing.
- Enter your practitioner name in the designated field. Ensure that the name matches the information on your state license.
- Circle your professional designation, selecting MD, DO, NP, or PA.
- Fill in your phone number and fax number in the appropriate sections.
- Provide your office address, noting that samples will not be sent to a P.O. box. Ensure the address is complete to prevent any delays.
- Input your city, state, and ZIP code correctly.
- Specify the product request by indicating the number of patient sample packs you wish to receive.
- List the product description along with the NDC# for ® (vilazodone HCl) in the corresponding fields.
- Read the certification statement carefully. By signing, you confirm that you are authorized to request the samples and will comply with regulations.
- Sign and date the form in the designated areas, and include your state license number and its expiration date.
- After completing all sections, you can save your changes, download the form, and prepare to fax it to the provided number along with a copy of your state license.
Complete your Samples request form online today to ensure you receive your complimentary samples promptly.
Related links form
The sample of a study is simply the participants in a study. In Brooke's case, her sample will be the students who fill out her survey. Sampling is the process whereby a researcher chooses her sample.
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