Create A New Practitioner Account

Please fill out the form below and make sure to upload a copy of your medical license for speedy processing. Within 1 business day, your account will be approved and login details emailed to you, or we will follow-up with you for more information if necessary.

Your name *

Your email address *

Business Name *

Specialty (MD, ND, DO, DC, retailer, etc.) *

Website

License Number (Medical License Number or Resale Tax ID#) *

Office Manager/Contact *

Street Address *

Address Line 2

City *

State / Province / Region

Postal / Zip Code

Country *

Business Phone Number *

Business Fax Number

How Did You Hear About Us? *

If Product Rep, Please State Who:

Please Upload a Copy of your Medical License
If not included, we will need to receive a copy via email or fax before we can authorize your account

^*Our products are not a suitable replacement for prescription medication and should not be used as a substitute. Results may vary. Content within and linked from this web page is for educational and informational purposes only, and not intended as a diagnostic or treatment guide for any disease or its symptoms. Statements on this page have not been evaluated by the FDA. This product is not intended to diagnose, treat, or prevent any disease.You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your regular health care provider.

Register Practitioner

Register Practitioner

Create A New Practitioner Account