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Prostate Cancer Site Policies

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Resources : Video : Brachytherapy video order form

Brachytherapy video order form

If you would prefer to order a free copy of the prostate brachytherapy video on either DVD or VHS format, please complete the form below with the relevant details.

Please note that the Prostate Cancer Centre will not keep any of your details or send you further information after your video has been sent to you. The information below will be sued only to contact you in an event of a problem with your delivery. For more information on our privacy policy please select this link.

Please complete all fields marked with (*). We will need this information to send you your video/DVD.
Name (*)

Address (*)
Address line 1
Address line 2
Town/City
County
Postcode
Email Address (*)
@ eg: bob@emailaddress.co.uk
Contact Telephone
Please include area code
What format would you prefer to receive?
DVD VHS video
Any comments or questions regarding the Prostate Cancer Centre?