Doctor / Clinic 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 the Doctor / Clinic order form below.

The price is $543.95 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.

Once purchased we will courier your DUROLANE to your clinic.  PLEASE ALLOW THREE WORKING DAYS FOR DELIVERY.


Doctor / Clinic Order Form

(who will be administering the injection)
Please ship DUROLANE to:
Patient Name: *
Patient Name:
(if known)
Quantity of DUROLANE Injections *
(if different from above)
(if required)
Payment Method: *
MM/YYYY
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 click Buy Now to make a Credit Card / Paypal payment.

Invoice

If you wish to pay by bank transfer, please tick the box on the order form above and we will send you an invoice.  
Please use the Invoice Number as reference when paying.

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

 

OR

Credit Card / PayPal

Click the "Buy Now" button below and follow the PayPal instructions.

ADD PAYPAL CODE BUTTON

  Please allow three working days for delivery.