Patient Kit

There are easy two ways to order your Vivally System.

Simply pick the option that works best for you. After you submit your information, we will ship your Vivally directly to you.

Have a Question?

Choose How to Order

1. Use the HIPAA-Secure Forms

Instantly submit your information and order your device with easy, fillable forms.

2. Download the Patient Kit

If you don't want to use our HIPAA-secure forms, download the patient kit, use a pen to fill out the PDFs and return to us via fax, email, or mail.

Use the HIPAA-Secure Fillable Forms

Submit Your Information in Seconds

Take Me to the Forms

Avation Offers Financing Options

Having questions about how to order the Vivally System? Not sure if your insurance will cover Vivally? Reach out to Customer Care. We can offer you financing options, answer your questions, and help you submit your forms.

Contact Customer Care

Email 888.972.5694

Choose How to Order

Instantly order with easy, fillable forms. Or, download the Patient Kit and email, fax, or mail in your order.

Submit Instantly

Use the Fillable Forms

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Submit via Email, Fax, or Mail

Download. the Patient Kit

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