Record Cease and Desist Letter to Doctors
After you have posted letters, use this form to record who you have contacted. It will then be displayed on a map showing the progress of the C&D campaign.

Once you've submitted this form, you'll have the opportunity to fill out a new form for other letters that you have sent. Just repeat for as many letters you have sent.

Please only use public available information (do not report any private address please).

Please don't add your own private name or your own private address, only add the publicly available name and address of the person(s) you sent the letter too. It doesn't matter who sent it, just who received it.
Sign in to Google to save your progress. Learn more
Doctors First and Last Name(s)
Add multiple Doctors names if sending to the same location. Create a new line by hitting the enter key for the additional names.
Additional Names....
Add more names here if you've run out of space above.
Business Name or Professional Name *
eg. Maroubra Medical Centre, Dutton Park Police Station, Daniel Andrews premier of Victoria, The Hon. (Brad) Bradley Ronald HAZZARD, BA, DipEd, LLB(NSW), LLM(Syd) MP
Street Address of Doctors Business *
eg. 12 Harper Street
Suburb of Doctors Business *
State of Doctors Business *
Country of Doctors Business *
Contact Method *
Comments
Enter email, tracking numbers or fax number if applicable and any other comments.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy