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Ministry of Health and Longer CareIndividual Eligibility Review Branch 3rd floor, 5700 Yong St. Toronto ON M2M 4K5Request for an Unlisted Drug Product Individual Clinical Review (ICR)Please fax completed

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Start by opening the sample request form.

02

Fill in your personal information such as name, address, and contact details.

03

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04

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05

Review the completed form for accuracy and completeness before submitting.

Who needs sample request for an?

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Anyone who is in need of a specific product sample for testing or evaluation purposes.

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Researchers, manufacturers, or consumers looking to try out a new product before making a purchase decision.

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What is sample request for an?

Sample request for an is a formal document submitted to request a sample of a particular product or service for review or testing purposes.

Who is required to file sample request for an?

Any individual or organization in need of reviewing or testing a sample of a product or service is required to file a sample request for an.

How to fill out sample request for an?

To fill out a sample request for an, provide necessary contact information, details of the requested sample, purpose of the request, and any specific instructions or requirements.

What is the purpose of sample request for an?

The purpose of a sample request for an is to obtain a sample of a product or service for evaluation, testing, or review before making a decision or purchasing.

What information must be reported on sample request for an?

Information such as requester's name, contact details, description of the requested sample, purpose of the request, quantity needed, and any specific requirements must be reported on a sample request for an.

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