Register to Order (Practitioner Only)

*First Name

*Last Name

*Practice Name

*Provider number or registration number

*Practice Address

*Suburb

*State

*Postcode

*Practice Phone #

*Username/Email

Tip: To help us quickly find your practice and upload your reports please make your username your first and last name. (spaces are allowed in your username) Example: Mary Smith

*Email

*Confirm Email

*Password

*Confirm Password

Tip: Please ensure you write down your password in a secure location as you will need it to enter the website when you want to place an order. You can reset your password at anytime using the lost password function on our login page

Practice Information

Please provide the following details about your practice

*Do you have a specialty?

*Please list the top five symptoms you most commonly see in your clinic?

*Are there any diagnostics and assessments that you are particularly interested in that we offer?

*How many new clients do you see each week?

*What type of conditions are typical with your patients?

*

I understand this website content and pricing is strictly for the account holder and is not to be disclosed to any 3rd party.

*

I understand on placing my first order, my credit card will be encrypted and stored by our merchant account provider to make ordering easy. I agree that at no time will i place a patients credit card into the system and I will be the authorised credit card holder.

Practice Information

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