HSA/FSA Information
Eligible customers may be able to use HSA or FSA funds for D’Vyne Organics Therapeutic Relief Cream with authorization from a licensed healthcare provider.
To support this process, we’ve provided a printable Topical Treatment Order that your provider can complete and sign. This document may be submitted with your receipt to your HSA/FSA administrator for reimbursement, subject to your plan’s terms.
👉 How it works:
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Download and print the Treatment Order form
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Bring the form to your healthcare provider for completion and signature
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Purchase the product using personal funds or HSA/FSA (depending on your plan)
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Submit the completed form and receipt to your HSA/FSA administrator for review
Reimbursement eligibility is determined by your individual plan.
Download Provider Treatment Order (PDF)
🔹FAQ Section
Is D’Vyne Organics Therapeutic Relief Cream HSA/FSA eligible?
Eligibility depends on your individual HSA/FSA plan. Some plans may reimburse topical products when prescribed or authorized by a licensed provider.
Does this guarantee reimbursement?
No. Submission of the form does not guarantee approval. Final determination is made by your HSA/FSA administrator.
Do you submit the form for me?
No. Customers are responsible for submitting the completed form and receipt to their HSA/FSA administrator.
Who can complete the form?
A licensed healthcare provider (such as a physician, nurse practitioner, or physician assistant).
🔹 Compliance-Safe Disclaimer
D’Vyne Organics does not guarantee HSA/FSA reimbursement. Eligibility and approval are determined solely by your plan administrator.
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