Patient Order Form

If you already have a medical prescription for Korasana products please complete the steps below and we will take care of the ANVISA import authorization for you.

  • Step 1

    Download and complete the Anvisa Power of Attorney
  • Click on the link to go to the download page → Anvisa POA
  • Step 2

    Upload all required documents. 1) ANVISA POA (signed and completed), 2) Patient Identification, 3) Prescription.
  • Drop files here or
    Accepted file types: jpg, png, jpeg, pdf.
      Please upload the completed and signed ANVISA POA.
    • Drop files here or
      Accepted file types: jpg, png, jpeg, pdf.
        Please upload a copy of your Government issued ID
      • Drop files here or
        Accepted file types: jpg, png, jpeg, pdf.
          Please upload a copy of your prescription issued by a Doctor.
        • Step 3

          Enter your personal information below. Note: This information must match the prescription that you received from your doctor.
        • Enter your date of birth
        • Please enter your 11 digit ID
        • Government agency who issued the ID
        • Enter your full address
        cussup t l - Patient Order Form
        cussup b r - Patient Order Form
        cus sup scaled - Patient Order Form
        You must be 18 years old to enter By entering this website, you certify that you are 18 years old or older.
        ×