New Account Application

Qualified health practitioners are welcome to register through the Biomed website, or download an application form PDF here. Once approved, an email will be sent to you with confirmation and your Biomedicine.com user login and password.

Not ready to apply for an account? Click here to arrange a consultation with one of our Education and Medical Support Specialists.


 
 
Contact information

Billing and Mailing Address:


Shipping Address (if different from billing information)


Example: (123)-456-7890
 

 
 
Authorization

Email

Credit Card Authorization *

 

 
 
Practitioner Certification

Certification *

Please upload your certification here. Alternatively you can email it to approvals@biomedicine.com or fax it to us at 1-866-881-2888.

 

 

Please indicate how you heard about us *

Please indicate your interests *

 

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Internet resellers must have a valid Minimum Advertised Price Agreement in place.

Do you plan to resell our products online? *