This form will automatically create a basic website account using the information you provide, not a healthcare account. Once you complete the form you will automatically be logged into your new basic account.
If you already have an account that you wish to upgrade to a healthcare account, use your existing account email and password information. We will upgrade your existing account, if approved.
You will not see healthcare pricing until your account is approved. Your new/existing account, until approved, can only shop with normal pricing. Once approved, you will automatically see healthcare level pricing.
If approved, you will be activated as a healthcare professional within 24-48 hours.
We only use your email address to provide receipts and tracking information. Save your password in a safe place.