Form

A completed Physician Authorization Form from a licensed medical practitioner is required prior to 110v products going to US locations at our UVB Store. We ship this device around the world directly from our production warehouse. We manufacture all kinds of outlets, you can choose according to the standards in your country or home. If it’s not in the options offered, you can write a note at the time of purchase.

For your convenience, we can send the Physician Authorization Form to your doctor by e-mail or fax. Please use the Contact Form on this page to make this request. In the Details section of the Contact Form, include: Patient Name, Physician Name, and your physician’s email address or fax number.

Orders can be placed up to 30 days before the Physician Authorization form is submitted.

US Medical Doctor Purchases

If you are a medical practitioner practicing in the USA and purchasing a UVB phototherapy product for treatment in your practice: At the time of purchase, complete and sign the Physician Information section of the Physician Authorization Form; Check the “UVB Lamp For Medical Office Use” checkbox, mark and date.

Fill in the contact form below to get the doctor authorization form