Patient Order Form

How to get DUROLANE

DUROLANE is distributed in New Zealand by LMT Surgical and is available for you to purchase now!
Call us on 0800 222 770 (Monday to Friday 9am - 5pm), or use one of the payment options below.
Once purchased we will courier your DUROLANE to your doctors clinic.
If you have any questions please feel free to contact us on 0800 222 770.

The price is $XXXXXX per DUROLANE injection (including freight and GST)

DUROLANE is a Medsafe registered medical device and therefore does not require a prescription. However it should be administered by a suitably trained medical practitioner.

Please fill out the order form below before you complete either a bank transfer or credit card payment.

PLEASE ALLOW THREE WORKING DAYS FOR DELIVERY.


Patient Order Form

Patient Name: *
Patient Name:
Please ship DUROLANE to:
Your DUROLANE injection will be couriered directly to the Doctor who will be administering the injection.
(who will be administering the injection)
Quantity of DUROLANE injections *
(if known)
Payment Method: *
Terms & Conditions of Sale *

Click here for full Terms and Conditions of Sale
Click here for our Privacy Policy


PAYMENT OPTIONS:

Please submit the order form above before you complete either a bank transfer or credit card payment.

PLEASE ALLOW THREE WORKING DAYS FOR DELIVERY.

Bank Transfer

If you wish to make a bank transfer using your online banking website, please tick the bank transfer box on the order form above and we will send you an invoice.

Price
The price is $XXXXX per DUROLANE injection (including freight and GST)

Reference
Please use the Patient Name as reference.

Your order will be sent to your doctor once we receive your payment.  Please allow three working days for delivery.