Practitioner Application Form

If you wish to apply for a practitioner account, please fill in the information below. We will review this information before getting back to you as soon as possible.

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Company Name

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Contact Name

Registered No

VAT No (if applicable)

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Contact Telephone Number

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Description of Business

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Email

Website Address

Instagram handle

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Account Password

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Confirm Password

Business Name/Address to

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Address Line 1

Address Line 2

Address Line 3

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Town/City

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Country

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Postal Code

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Certificate of Membership

Please upload a copy of your certificate of membership with the appropriate regulatory body. (e.g. Association of Naturopathic Practitioners, National Institute of Medicinal Herbalists)

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How did you hear about us?

-select option-Existing customerWeb searchInstagramFacebookWord of mouthMagazineLetter/Physical MailingHealth StoreEmailOther

if you selected other, please specify

Allow communication

Yes

Tick the box above to receive practitioner communications from us regarding promotion and latest products

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Please add the two numbers

Submit Application