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PATIENT INTAKE FORM

PATIENT INTAKE FORM

Description:

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Get Patient Information Efficiently

Patient Intake forms are perfect for your pharmacy tech to get all the necessary information when accepting new patients at the pharmacy.  Don’t waste time asking the same questions twice!

  • Forms are 5 ¼” high, 4 ⅛” wide
  • They are printed in black ink on high quality 20 lb. canary paper
  • In pads of 100
  • Minimum quantity is 1,000 forms (10 pads)

*Also available in Pink, Green, or Blue.  MINIMUM quantity of 5,000 required for paper colors other than Canary.

QUANTITY

1,000 (10 Pads) for $31.15, 2,000 (20 Pads) for $59.95, 3,000 (30 Pads) for $88.85, 5,000 (50 Pads) for $144.50, 10,000 (100 Pads) for $281.25
SELECT A COLOR

Canary, Green, Pink, Blue

Starts at $31.15
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1,000 (10 Pads) for $31.15 $31.15
You save
2,000 (20 Pads) for $59.95 $59.95
You save
3,000 (30 Pads) for $88.85 $88.85
You save
5,000 (50 Pads) for $144.50 $144.50
You save
10,000 (100 Pads) for $281.25 $281.25
You save

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