Healthera App Launch Pack Order Form

Name *

Your E-Mail (please double-check this is correct otherwise it will end up in our spam) *

Mobile Number *

Pharmacy Name(s) and Postcode(s) *

Which Launch Pack are you interesting in? *

Are you already a Pharmacy Mentor customer? *

Please specify your website address(es) (URL) if you have one.

Do you have a Facebook profile? *

How many branches do you want help with?

Please specify your dedicated Healthera download link(s) if you know them

Do you have any other information you’d like to provide?

Tick the box if you would like us to send you occasional support material to help you market your pharmacy better?

0 + 4 = ?Please prove that you are human by solving the equation *