Varithena direct order form

Use this form to place an order for a Varithena product.

*All fields required unless noted below.

Account name

Account number

PO #

Contact first name

Contact last name

Email address

Phone Number

Shipping street address

Shipping city

Shipping state

Shipping zip code

VARITHENA canister quantity

VARITHENA Canister, Product #FP00019 Varithena Canister Special Instructions:

VARITHENA Admin Pack Quantity* (minimum order quantity of 3 is recommended when ordering admin packs)

VARITHENA Admin Pack, Product #FP00024 Varithena Admin Pack Special Instructions:

Authorized by (Full Name)

By submitting this form, you agree to the privacy policy and terms of use.

Please note:

State and local sales taxes apply in certain states. Orders submitted after 1:30pm CT will be processed the next business day. For order questions, call: (855) 971-8346 (VEIN). All orders for Varithena are shipped ground and can take up to 5 business days to arrive to you.

White circle label for Varithena product, indicating branding and identification for clinical use.

Questions or concerns about Varithena?

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Contact a sales representative.

Have your local Varithena sales representative contact you regarding Varithena.

Contact a representative

Customer care and product complaints.

Communicate questions and complaints about Varithena.

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