Request a product sample or visit from L&R staff – L&R (formerly Activa Healthcare)

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Request*

Name of product(s)

Reason for visit*

First name*

Last name*

Job Title/Role*

Phone*

Email*

Work address Base/Clinic*

Address 1*

Address 2

Town*

County

Postcode*

L&R Medical UK Ltd will use the information provided to respond to your request in accordance with our privacy policy.

Also use my data to inform me about products, services and other activities

Do not use my data for any other purpose