New to Prescription
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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Healthcare Professional Details
We offer educational events and home visits in selected areas. Home visits are conducted by our dedicated and qualified nursing team to support you with the products you are currently using. If you would like to hear more about our services please tick the box below.