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Cancel Order Form

Cancel Order Form

Thank you for using the Sirtex Online Cancellation Form. Please complete the fields below to complete your request. After your cancellation is submitted, you will receive a confirmation of receipt from Customer Service. If you have any questions, please email csusa@sirtex.com or call us on one of our numbers listed on our Contact page.

Cancellation Request





QUANTITY TO CANCEL
Quantity Item Number Item Description
SLLES182 LAVA Liquid Embolic System 2 mL, 18
SLLES186 LAVA Liquid Embolic System 6 mL, 18
SLLES342 LAVA Liquid Embolic System 2 mL, 34
SLLES346 LAVA Liquid Embolic System 6 mL, 34
SLLESMK2 LAVA Liquid Embolic System LAVA 2 mL Mixing Kit
SLLESMK6 LAVA Liquid Embolic System LAVA 6 mL Mixing Kit







* mandatory field