Practitioner Registration

Practitioner Accounts are for licensed healthcare practitioners who would like to prescribe Microvascular Health Solutions’ products to their patients.

Personal Information
Name(Required)
First Last
Professional Title
Specialty
Your Display Name
Practice Information
Practice Name(Required)
Practice Phone(Required)
Practice Email(Required)
Enter Email Confirm Email
Website
Hospital/Practice EIN(Required)
Practice Address
Address(Required)
Practice Street Address Practice Street Address Line 2 Practice City Practice State or Province Practice Zip/Postal Code Practice Country
Personal Mailing Addresses
Personal Address
Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Personal Shipping Address
Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Information
Phone(Required)
Time Zone(Required)
Email(Required)
Enter Email Confirm Email
Receive Newsletter/SMS Messaging (Unsubscribe at anytime)
Your Account Information
User Name(Required)

If you type "bob" in the Username Input your Personal "Microvascular Health Solutions" web address will be: https://microvascular.com/bob All website address names are subject to approval by Microvascular Health Solutions.
Choose Your Password(Required)

Mixed case required (one uppercase and one lower case)
Terms of Service
Consent(Required)
By Checking this box, I agree that I am 18 years of age or older.(Required)
Consent(Required)
I will submit a copy of my professional license within 72 hours. The copy of your license you be emailed to prosales@microvascular.com(Required)
Consent(Required)
By Checking this box, I agree to the Terms & Conditions(Required)
Consent(Required)
By Checking this box, I agree to the Income Disclosure(Required)
Consent(Required)
By Checking this box, I agree to the Policies & Procedures(Required)
Consent(Required)
By Checking this box, I agree to the Electronic Signature(Required)
Please type your full name(Required)

Practitioner Registration

Personal Information

Practice Information

Practice Address

Personal Mailing Addresses

Contact Information

Your Account Information

Terms of Service