• Nursing Supply Order Form

  • Format: (000) 000-0000.
  • OLYMPIA SUPPLY
  • AESTHETIC INJECTABLES - NEUROTOXIN
  • OLYMPIA KITS
  • OPERATING SUPPLIES (MCKESSON)
  • I WANT TO ORDER WHOLESALE PRODUCTS (Check all that apply) *** These will be handled through MSO if not MD Account
  • Cold Ship/ Pharmacy Orders

    Patient Specific Orders - Please enter any further detailed or requested info in long narrative box at end of form
  • Patient Specific Order 1
  • Patient Specific Order 2
  • Patient Specific Order 3
  • Patient Specific Order 4
  • Patient Specific Order 5
  • Patient Specific Order 6
  • Nurse Injector Supplies

    These are based from Moxie group pricing, pricing subject to change **will update this form when pricing available
  • My Products

    Categories:All
    All
    Dermal Filler
    ALLERGAN PRODUCTS
    GALDERMA PRODUCTS
    MERZ PRODUCTS
    EVOLUS PRODUCTS
    REVANCE PRODUCTS
    NEUROTOXIN
    SKIN BOOSTER
    BIOSTIMULATORY
    Sort By
    Name: A to Z
    Name: Z to A
    Price: Low to High
    Price: High to Low
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                                Restylane Fillers (1 syringe per box) $260-360 ea
                                Free$ Free
                                  
                                RHA Fillers (Redensity, RHA2, RHA3, RHA4)
                                $390.00$390.00
                                  
                                Product Name
                                Free$ Free
                                  
                                Dermal Filler
                                Restylane Fillers (1 syringe per box) $260-360 ea

                                Available upon request, this is not a product typically ordered at Luxe. Minimum order quantity 8 box

                                Free$ Free
                                  
                                RHA4 - DYNAMIC VOLUME (2 pack) $390 ea. Can mix and match with RHA Line products Minimum purchase 5 boxes
                                RHA4 - DYNAMIC VOLUME (2 pack) $390 ea

                                Can mix and match with RHA Line products

                                Minimum purchase 5 boxes

                                $390.00$390.00
                                  
                                RHA3 (2 pack) $390 ea. Can mix and match with RHA Line products Minimum purchase 5 boxes
                                RHA3 (2 pack) $390 ea

                                Can mix and match with RHA Line products

                                Minimum purchase 5 boxes

                                $390.00$390.00
                                  
                                RHA2 (2 pack) $390 ea. Can mix and match with RHA Line products Minimum purchase 5 boxes
                                RHA2 (2 pack) $390 ea

                                Can mix and match with RHA Line products

                                Minimum purchase 5 boxes

                                $390.00$390.00
                                  
                                RHA Redensity (2 pack) $390 ea. Can mix and match with RHA Line products Minimum purchase 5 boxes
                                RHA Redensity (2 pack) $390 ea

                                Can mix and match with RHA Line products

                                Minimum purchase 5 boxes

                                $390.00$390.00
                                  
                                RHA Fillers (Redensity, RHA2, RHA3, RHA4)

                                minimum order 5 boxes

                                Comes 2 syringes per box

                                $390.00$390.00
                                  
                                Evolysse Form 1ml. minimum order 10 (can mix and match with Evolysse Smooth)
                                Evolysse Form 1ml

                                minimum order 10 (can mix and match with Evolysse Smooth)

                                $170.00$170.00
                                  
                                Evolysse Smooth 1ml. minimum order 10 (can mix and match with Evolysse Form)
                                Evolysse Smooth 1ml

                                minimum order 10 (can mix and match with Evolysse Form)

                                $170.00$170.00
                                  
                                Radiesse Dual Pack. Dual pack (1.5ml ea) minimum order 3
                                Radiesse Dual Pack

                                Dual pack (1.5ml ea)

                                minimum order 3

                                $478.00$478.00
                                  
                                Belotero 1ml. minimum quantity 3
                                Belotero 1ml

                                minimum quantity 3

                                Free$ Free
                                  
                                ALLERGAN PRODUCTS
                                Skinvive by Juvederm (2 syringe per box). Minimum purchase quantity 3
                                Skinvive by Juvederm (2 syringe per box)

                                Minimum purchase quantity 3

                                $380.00$380.00
                                  
                                Neurotoxin Botox Cosmetic 50unit. Minimum order quantity 3
                                Neurotoxin Botox Cosmetic 50unit

                                Minimum order quantity 3

                                $375.00$375.00
                                  
                                Neurotoxin Botox Cosmetic 100 units. Minimum order quantity 3
                                Neurotoxin Botox Cosmetic 100 units

                                Minimum order quantity 3

                                $675.00$675.00
                                  
                                GALDERMA PRODUCTS
                                Sculptra (2 bottles per box). Minimum order 3 boxes
                                Sculptra (2 bottles per box)

                                Minimum order 3 boxes

                                $520.00$520.00
                                  
                                Neurotoxin Dysport 300 units. Minimum order quantity 4
                                Neurotoxin Dysport 300 units

                                Minimum order quantity 4

                                $476.00$476.00
                                  
                                MERZ PRODUCTS
                                Neurotoxin Xeomin 50 unit. minimum quantity 5
                                Neurotoxin Xeomin 50 unit

                                minimum quantity 5

                                $278.00$278.00
                                  
                                Neurotoxin Xeomin 100 unit. minimum quantity 5
                                Neurotoxin Xeomin 100 unit

                                minimum quantity 5

                                $521.00$521.00
                                  
                                Radiesse Dual Pack Product Image
                                Radiesse Dual Pack
                                $478.00$478.00
                                  
                                Belotero 1ml Product Image
                                Belotero 1ml
                                Free$ Free
                                  
                                EVOLUS PRODUCTS
                                Neurotoxin Jeuveau 100 units Product Image
                                Neurotoxin Jeuveau 100 units
                                $390.00$390.00
                                  
                                Evolysse Smooth 1ml Product Image
                                Evolysse Smooth 1ml
                                $170.00$170.00
                                  
                                Evolysse Form 1ml Product Image
                                Evolysse Form 1ml
                                $170.00$170.00
                                  
                                REVANCE PRODUCTS
                                Neurotoxin Daxxify 100 units. Minimum order quantity 10
                                Neurotoxin Daxxify 100 units

                                Minimum order quantity 10

                                $305.00$305.00
                                  
                                RHA Redensity (2 pack) $390 ea Product Image
                                RHA Redensity (2 pack) $390 ea
                                $390.00$390.00
                                  
                                RHA2 (2 pack) $390 ea Product Image
                                RHA2 (2 pack) $390 ea
                                $390.00$390.00
                                  
                                RHA3 (2 pack) $390 ea Product Image
                                RHA3 (2 pack) $390 ea
                                $390.00$390.00
                                  
                                RHA4 - DYNAMIC VOLUME (2 pack) $390 ea Product Image
                                RHA4 - DYNAMIC VOLUME (2 pack) $390 ea
                                $390.00$390.00
                                  
                                NEUROTOXIN
                                Neurotoxin Jeuveau 100 units Product Image
                                Neurotoxin Jeuveau 100 units
                                $390.00$390.00
                                  
                                Neurotoxin Xeomin 100 unit Product Image
                                Neurotoxin Xeomin 100 unit
                                $521.00$521.00
                                  
                                Neurotoxin Xeomin 50 unit Product Image
                                Neurotoxin Xeomin 50 unit
                                $278.00$278.00
                                  
                                Neurotoxin Daxxify 100 units Product Image
                                Neurotoxin Daxxify 100 units
                                $305.00$305.00
                                  
                                Neurotoxin Dysport 300 units Product Image
                                Neurotoxin Dysport 300 units
                                $476.00$476.00
                                  
                                Neurotoxin Botox Cosmetic 100 units Product Image
                                Neurotoxin Botox Cosmetic 100 units
                                $675.00$675.00
                                  
                                Neurotoxin Botox Cosmetic 50unit Product Image
                                Neurotoxin Botox Cosmetic 50unit
                                $375.00$375.00
                                  
                                SKIN BOOSTER
                                Skinvive by Juvederm (2 syringe per box) Product Image
                                Skinvive by Juvederm (2 syringe per box)
                                $380.00$380.00
                                  
                                BIOSTIMULATORY
                                Radiesse Dual Pack Product Image
                                Radiesse Dual Pack
                                $478.00$478.00
                                  
                                Sculptra (2 bottles per box) Product Image
                                Sculptra (2 bottles per box)
                                $520.00$520.00
                                  
                                Total
                                $0.00$0.00
                              • ORDER POLICY & ACKNOWLEDGMENT

                                By submitting this order, I acknowledge and agree to the following:

                                • An invoice will be issued via QuickBooks for all submitted orders.
                                • Payment in full is required prior to order fulfillment. No orders will be placed or released until the invoice has been paid.
                                • All orders will be delivered to the Angola office location 
                                • Shipping, handling, and cold shipping fees (if applicable) will be added to the invoice and are the responsibility of the ordering provider.
                                • To qualify for same-week fulfillment, all orders must be submitted and paid in full no later than Tuesday at 5:00 PM.
                                • Orders received or paid after this time will be processed the following week.
                              • Should be Empty: