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COMPANY
About Lavior, Inc.
Advisory Board
Executive Team
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Clinical Studies
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Dispensing Product
I am interested in...
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Doctor Direct (in-office dispensing)
Patient Direct (zero-inventory dispensing)
Combining Doctor Direct and Patient Direct
Do You Currently Dispense Out Of Your Office?
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Yes
No
Select the Lavior product(s) you are most interested in dispensing
*
Lavior Natural Diabetic First Aid Gel
Lavior Natural Diabetic Wound Care Gel
Lavior Natural Daibetic Anti-Fungal Ointment
Lavior Diabetic Dry Skin Moisturizer
Lavior Diabetic Itch Relief Cream
Lavior Natural Eczema Relief Cream
Lavior Natural Wound Care Gel
Practice Contact Information
Practice/Facility Name
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Physician Name
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Office Manager or Secondary Contact
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Practice Information
Do You Have Satellite Locations?
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Yes
No
Number of Physicians in Practice
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Please Select
1
2
3
4
5
6
7
8
9
10
More than 10
Number of Treatment Rooms
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1
2
3
4
5
6
7
8
9
10
More than 10
How many diabetic patients do you see on a weekly basis?
*
How many wound care patients do you treat on a weekly basis?
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