Purchase ProLon® with your physician's approval

If you haven't taken the ProLon Self Assessment to see if you need physician approval to purchase Prolon, please do so here. If you have already taken the assessment and you are returning to submit approval please read on.

Thank you for your interest in ProLon and for taking the time to discuss your desire to use ProLon with your health care provider. Please click on the button below to enter your physician's information and obtain your ProLon purchase authorization code.

We will not contact your provider to confirm your approval, but we need the information to keep on file. Your information will be kept secure and never shared with any third party.