About Us
Providers
Patients
Onboarding
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–
Step
1
of 2
Provider's Full Name
*
Provider's Phone
*
Provider's Email
*
Provider's NPI
*
Provider's Profession
*
MD
DC
LNP
RN
PT
ATC
Clinic Name
*
Clinic Office contact's name
*
Office Email
*
Office Phone
*
Clinic Address
*
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you have a stem cell certification?
*
Yes
No
What training is needed?
*
Intraarticular Injection
Spine injection
IV therapy
Stem cell handling
Stem cell legal compliance
None
Next
provide you
Do you want to be on our list of providers?
Yes
No
What medicine, treatments, body parts, or other skills do you specialize in?
What is your target demographic?
Is there are certain sport or hobby you are passionate about?
What is the best way to send you referrals?
Do you have any social media accounts? (Please list them)
What are your practice's values? What makes you stand out from other clinics?
Are there any other unique services you provide we could let patients know about?
Do you do any virtual services?
Yes
No
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