Dermatology Patient Evaluation Product Order Form

For UK Healthcare Professionals only

Thornton & Ross provides Patient Evaluation Products as a service for dermatology patients delivered via Health Care Professionals. This service allows dermatology patients to try our product range of emollients, ensuring patient acceptability before a prescription is written.

    Please select Zeroderma, Cetraben or both

    Please select Zeroderma patient evaluation products:

    Zerobase

    Zeroveen

    Zerocream

    ZeroAQS

    Zerodouble

    Zeroderm

    Please select Cetraben patient evaluation products:

    sample cream

    Cetraben Cream

    sample ointment

    Cetraben Ointment

    sample lotion

    Cetraben Lotion

    Your details

    Name

    NHS Email* / Phone number

    Professional Code

    Role*

    Hospital/Practice Details*

    NHS Work Address*

    How did you hear about our Patient Evaluation Products?

    Please tick to confirm

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    Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Thornton and Ross Limited by emailing thorntonross@medinformation.co.uk or by calling 01484 848164.

    UK-MULT-281(1) | August 2024

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