Welcome to the Supply Center

 

 

ATTENTION NEW CUSTOMERS

If you are new to The Supply Center, please complete the following information below.

 

First Name:
Last Name:
 
Street Address:    
City:    
State / Province: Postal Code:
 
Phone: E-mail:
 
I am currently a student.   Which school are you attending?

Type of Program:


If other, please specify:

I am a healthcare professional.    
     
If you are a healthcare professional, you will be required to submit a copy of your license or certification. The Supply Center will contact you for this information as we process your registration.
 
Type of healthcare practitioner:    
   
Professional Title:    
License Number:    
   
 

Tell us about the clinical modalities used your practice:

Acupuncture   Electro Stim
Herbs Lasers
Vitamins & Supplements
     
     

 


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