Please fill out the form below to apply for your account. If approved, you will be able to order bulk quantities at discount pricing. Please note that the minimum order quantity is 3. If you require less than 3 units please register a normal customer account or simply complete checkout without signing in.

Login Information

Enter the email and password you would like to use to login to and verify your practitioner account.

Personal Information

We will only use the following information to reach out to you during our approval process and for updates on new products or offerings.

Your Practice

The information below will only be used to contact you or your practice with any general questions regarding your orders.

Social Media

Your personal data will be used to support your experience throughout this website, to manage access to your account, and for other purposes described in our Privacy policy.