Bp Premier New Product Request Form New Product Request Form (Bp Premier) A form provided to pharmaceutical companies wishing to have their products added into the Bp Premier product list. What is your product's trading name?(Required) What is your product's ARTG ID(Required) e.g. AUST R, AUST L. Please submit a separate form for each ARTG ID.List your product's active ingredient(s) and strength(s)(Required)Provide your product's active ingredients and their strengths as they appear on the product label. e.g. 50mg Cannabidiol (CBD) per 2g dose.What dose form does your product take?(Required) e.g. coated tablet, dental paste, eye drops.Company name(Required) Please provide the name of the company handling enquiries for this product.Is your product currently available?(Required) Yes No When will your product be available?(Required) MM slash DD slash YYYY How is your product obtainable?(Required) Normal Supply Chain Special Circumstances Comments on special circumstances to obtain(Required) e.g. SAS-B, Medicinal CannabisPoisons Schedule category(Required) 2 3 4 5 6 7 8 If your product is Medicinal Cannabis, please select the TGA category 1 2 3 4 5 Does your product's Poisons Schedule category vary with pack size?(Required) Yes No If applicable, please provide more information on Poisons Schedule variance Please provide additional product details below:If applicable, what colour is your product? If applicable, what shape is your product? Is your product scored?(Required) Half Quarter No Not Applicable If applicable, please describe any markings on your product If applicable, please describe your product's flavour Does your product contain gluten?(Required) Yes Contains a starch compound of unknown origin No Not Applicable Does your product contain lactose?(Required) Yes No Not Applicable Does your product contain latex?(Required) Yes No Not Applicable Contact Details (for internal use only)Preferred title(Required) Mr Mrs Ms Miss Dr Prof Other First Name(Required) Last Name(Required) Role Title(Required) Contact Phone Number(Required) Email Address(Required)
