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Complete the form to take
advantage of the following offer:

If you are a physician or nurse practitioner in the U.S., you can receive Divigel® samples by mail to support patient trial and use. Divigel® samples come with a convenient travel case for your patients.

To receive samples by mail, please follow these steps:

  1. Fill in the information in the form and click submit
  2. Print and sign the confirmation form—your signature and the date are required to authorize samples
  3. Fax the completed confirmation form to Vertical Pharmaceuticals, LLC at 1-866-315-4753
If your practice is in a location where we have a sales representative, one will visit your office to provide you with Divigel® information and samples.

Save on Divigel®:

With the savings coupon, your patients can save up to $25* on their Divigel® copay amount. The savings coupon would be valid for each of their next 12 Divigel® prescriptions. Please click here for terms and conditions.

Coupon

*Vertical Pharmaceuticals, LLC reserves the right to amend or cancel this offer without notice. For eligible patients only and limited to a maximum savings of $25 each on 12 Divigel® prescriptions. Subject to eligibility rules; restrictions apply. See full details on the coupon.

 
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If you are unable to complete your sample request, please call 1-866-600-4799 for assistance.

 

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400 Crossing Blvd.
Bridgewater, NJ 08807

Phone: 908-809-1300

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