Thank you for registering your patient with Countrywide Supplies.
Step 1: Please complete the form below to register your patient with us.
Step 2: Use the comment box to place your patient's first order and to add any specific requirements. Please indicate product codes, names and quantities.
Step 3: Click Create Account to finalise your patient’s registration. Your patient will then receive a call from our dedicated Customer Care Team.
Please note: Once a patient registration has been finalised, you will not be able to make any changes to the registration. For more information please contact firstname.lastname@example.org
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