pagesize A4
at 27x33 field 40 (config/doctor)
at 27x40 field 40 (mystreet1fld/text)
at 20x47 field 60 (mystreet2fld/text)
at 20x54 field 60 (mycityfld/text)
at 32x62 field 40 (myfxfld/text)
at 30x69 field 40 (myregistrationfld/text)
at 110x26 field 40 (ssnfld/text)
at 110x33 field 40 (fnamesfld/text)
at 110x40 field 40 (surnamefld/text)
at 110x47 field 20 (dobfld/text)
at 100x55 field 40 (street1fld/text)
at 100x63 field 40 (street2fld/text)
at 100x70 field 40 (townfld/text)
at 100x79 field 40 (cityfld/text)
at 15x115 check data none
at 15x126 check data none
at 15x141 check data none
at 15x152 check data true
at 15x184 check data none
at 21x197 check data none
at 21x208 check data true
at 50x225 field 40 (miscell1fld/text)
at 15x250 check data none
at 105x330 field 40 (form now/date)

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File			Size	Date	Attached by
		sa0797.eps EPS version of application form	177.51 kB	02:28, 5 Jan 2008	Graham	Actions
		sa0797.pdf Original PDF version of application form	4.94 kB	02:28, 5 Jan 2008	Graham	Actions

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PNG version of application form
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Alendronate

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