Register veterinary practice

By registering, you are showing interest in supplying NumOcaine to welfare focused farmers.

NumOcaine is S4 and will only be available thorough Vet Supply. Register below to indicate your Vet Surgery is interested in supplying NumOcaine.
First Name*
Last Name*
Phone Number
Email*
Country
Your Vet Practice Type
Zip Code
NumOcaine is S4 and will only be available thorough Vet Supply. Register below to indicate your Vet Surgery is interested in supplying NumOcaine.
No. of livestock farms our practice looks after:-
- Zero
- 1-5
- 6-20
- 20+
Name of Practice Manager
If you wish to distribute NumOcaine please provide this information required for the Supply of Scheduled Products.
Authorised Veterinarian's Name
First Last
Position
Year graduated:
Registration Number:
Registered Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code
Qualifications
Please include withe completed application a photo of the Veterinary Surgeons certificate of registration for the above named person responsible for ALL scheduled drugs purchases. We require a current certification that shows an expiration date.
Accepted file types: pdf, jpg, png, jpeg, Max. file size: 2 MB.
If you have your certificate of registration on iCloud, Google Drive or Office 365 then you can paste the link here:
I would like my location being shown on a public map so sheep farmers can find me as a NumOcaine reseller.
- I Agree
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Comments
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