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APPLICATION FORM LAVANYA HEALTH CARE
PLEASE FILL THE FORM CORRECTLY
Name
First
Last
EDUCATIONAL QUALIFICATION *
*
Date Of Birth
MM
/
DD
/
YYYY
Current Age
Phone
###
-
###
-
####
Alternate Ph. Number
Your Email
*
Alternate Email
COURSE INTERESTED IN *
*
Patient Counseling
Diabetic care
Pharmacy practice
Medical representative sales management
Pharmaceutical whole sale and drug store Management
Community Pharmacy and Health
Pharmaceutical marketing.
Drug interaction and Its Identification
Prescription Handling
Pharmacovigilance
PLS TICK INTERESTED COURSE.
REASON FOR SELECTING THE COURSE
*
UPLOAD SOFT COPY OF EDUCATIONAL DOCUMENTS.
*
Please upload your previous educational qualification data in pdf or word format in ascending order.
PASSPORT SIZE PHOTO UPLOAD.
PLEASE UPLOAD YOUR PASSPORT SIZE PHOTO IN ,JPEG ,TIF ,GIF .PDF ,PNG FORMAT ONLY
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