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LTCI NOW Form
LTCI NOW Form
For Pet Owners: Please print this out and provide this sheet to your veterinarian. LTCI is
available to licensed veterinarians in the United States from IMULAN BioTherapeutics. You may also
visit www.IMULAN.com/NOW to find local veterinarians that currently use LTCI. THE ORDER
FORM IS ATTACHED.
Rebate: IMULAN will issue the following reimbursement directly to owners within 30 days of proof of
receipt.
a. $20.00 for every 3-pack.
b. $35.00 for every 10-pack
Veterinarians must purchase product directly from IMULAN in order to be eligible for reimbursement.
This offer is only good until end of 2009. No product purchased after 2009 will qualify. Please fax your
veterinarians proof of purchase or your receipt to 866.603.9526.
For Veterinarians: LTCI is a potent regulator of CD-4 lymphocyte production and function. It has
been shown to increase lymphocyte numbers and IL-2 production in animals. Lymphocyte T-Cell Immune
Modulator is intended as an aid in the treatment of cats infected with feline leukemia virus (FeLV) and/or
feline immunodeficiency virus (FIV), and the associated symptoms of lymphopenia, opportunistic
infection, anemia, granulocytopenia, or thrombocytopenia.
How to Order: IMULAN may be ordered directly from IMULAN BioTherapeutics, LLC. by a licensed
veterinarian via fax (866-603-9526), online order (IMULAN.com/order), or over the phone (816-749-4016).
How Supplied: LTCI is supplied in 3-dose or 10-dose packs. LTCI is administered by subcutaneous injection
upon diagnosis of the presence of FIV or FeLV disease. LTCI may be given weekly for the first month, then every
other week for second month, then monthly or as necessary thereafter depending on the patient's response.
This product license is conditional. Additional efficacy and potency test studies are in progress.
Doctor Name:
Hospital Name:
Phone Number:
Fax Number:
email:
Shipping Address:
Hospital Name
Street Address
City, State and Zip
P.O. Number
(if applicable)
Expiration Date:
Security Code:
(3 digit code on back of credit card)
Billing: Street Address
City, State and Zip