PARASITICIDE PRODUCTS FORM

THIS FORM IS FOR USE BY REPRESENTATIVES OF PHARMACEUTICAL COMPANIES. THE INFORMATION WILL BE USED TO UPDATE THE VETERINARY PRESCRIBER PARASITICIDES GUIDES. THE INFORMATION WILL BE VERIFIED BEFORE ENTRY INTO THE GUIDE. USE THIS FORM FOR A NEW PRODUCT OR FOR CHANGES TO AN EXISTING PRODUCT. 

For help or enquires regarding this form please email veterinaryprescriber@gmail.com

Name of person completing form *
Name of person completing form
Enter your role or position in the company
Enter the brand name of the parasiticide product
Please list the active ingredient(s) in the product
Enter the formulation of the parasiticide product. If there is more than one formulation, use a different form for each one.
List the authorised species as in the SPC. If the product is authorised for more than one species then please use a separate form for each.
List the authorised indications as in the summary of product characteristics
Is it active against flea larvae?
Treatment interval (ectoparasiticides only)
Use recommended in pregnancy? (As stated in SPC)
Minimum age and/or weight (as in SPC)
Supply category (AVM-GSL, NFA-VPS or POM-V)