For children weighing
16.5lbs to 33 lbs.
For children weighing
33 lbs to 66 lbs.
For anyone who
weighs 66 lbs or more.

AUVI-Q® for Airlines Order Form

Initiate your AUVI-Q order for airlines and HealthFirst will respond with your pricing, and answer any questions you may have. If you need assistance please call (855) 476-1313. 

You can order by completing one of the following options:

  1. Submit the online form below. Upload and attach your prescription from an authorized physician and the state-issued physician’s license certificate.
  2. Download the AUVI-Q Order Form PDF and email to auviq@healthfirst.com. Attach the prescription and physician license to the email.
    Payment information will be collected via phone during the order confirmation process.
  • For patients weighing 16.5-33 lb. Please indicate the total number of cartons requested for each dose. Each carton contains 2 auto-injectors and 1 trainer.
  • For patients weighing 33-66 lb. Please indicate the total number of cartons requested for each dose. Each carton contains 2 auto-injectors and 1 trainer.
  • For patients weighing over 66 lb. Please indicate the total number of cartons requested for each dose. Each carton contains 2 auto-injectors and 1 trainer.
  • Drop files here or
    Please upload and attach your prescription from an authorized physician and the state-issued physician’s license certificate.