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Stavzor

Request STAVZOR samples

Noven Therapeutics is pleased to provide STAVZOR samples for you to offer your patients.

Please enter your information below to generate a Sample Request Form to receive samples of STAVZOR for the treatment of bipolar mania, epilepsy or migraine prophylaxis.



Step 1: FILL OUT this form completely. (Complete all required fields)
Note: all fields marked with an asterisk ( *) must be filled in.

*First Name: Middle Initial:
* Last Name:
*Practitioner's
Designation:
*State License No: *Exp Date:
*Address:
(PO Boxes are not accepted)
Suite / floor
*City
*State: *Zip Code:
*Office phone: Fax:
(ex XXX-XXX-XXXX)
*Email:
Please Check the box for each sample dose requested:
  STAVZOR 250mg : 10 bottles
  STAVZOR 500mg : 10 bottles
The information I provided here may be used by Noven Therapeutics to contact me in the future
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If you have any questions regarding your sample request, please call 877-493-3619.
Save up to $50 off every prescription