Sample Request

Vivelle-Dot^®: The Smallest ET Patch Available

Please enter your information below to generate a Sample Request Form to receive samples of Vivelle-Dot, the smallest ET patch available for the treatment of moderate to severe hot flashes, night sweats, and vaginal atrophy and dryness associated with menopause and the prevention of postmenopausal osteoporosis.

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* Required Fields

* First Name:

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Middle Initial:

* Last Name:

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* Practitioner's Designation:

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* Practice Name:

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* State License Number:

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* Expiration Date:

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Please check box for each sample dose requested.

DESCRIPTION	NDC	QTY
Vivelle-Dot 0.025 mg/day	0078936501	10 boxes (20 patches)
Vivelle-Dot 0.0375 mg/day	0078934301	10 boxes (20 patches)
Vivelle-Dot 0.05 mg/day	0078934401	10 boxes (20 patches)
Vivelle-Dot 0.075 mg/day	0078934501	10 boxes (20 patches)
Vivelle-Dot 0.1 mg/day	0078934601	10 boxes (20 patches)

Please do not change the designated quantities; otherwise, the sample request will be denied. Samples will be distributed via courier within two weeks of request.

^* The information I provided here may be used by Novogyne Pharmaceuticals to contact me in the future.
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Sample Request

Vivelle-Dot®: The Smallest ET Patch Available

Vivelle-Dot^®: The Smallest ET Patch Available