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Home
About
Practitioners
Contact
Natural Products
Practitioners
Apply for a wholesale Account.
You must be a licensed healthcare practitioner to apply for an account.
Name
*
First Name
Last Name
Email
*
Phone Number
*
(###)
###
####
Company Name
License Type
*
Acupuncture
Chiropractor
Herbalist
Holistic Medicine
Homeopathy
Medical Doctor
Naturopath
Nurse/Registered Nurse
Osteopath
Physical Therapist
Student of TCM
Veterinarian
Other
License #
*
Practitioners outside of US where licenses are not required, enter 'INT'; TCM Students, enter 'STU'
Expiration Date
*
Licenses with no expiration date, licenses not required, or TCM Students, enter today's date
MM
DD
YYYY
Thank you!