Download, complete, and sign the LIVALO sample request form.
Fax the completed form to
1-334-272-6034. Please allow 7-10 days for delivery.
If eligible, your patients may be able to pay as little as $18 a month for their LIVALO refills.*
Certain rules and restrictions apply. Please see eligibility criteria, along with offer terms and details, on the LIVALO® Savings Card.
The information contained in this site is technical in nature and was designed specifically for Healthcare Professionals. To proceed, please choose one of the following:
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This policy may be modified from time to time, and changes will be communicated promptly on this page.