Provider Registration Step 3

Create Account

Vendor Registration

Submit the form below to become a vendor on this store.

First Name *

Last Name *

Login Username *

Email *

Confirm Email *

Vendor Name * Important: This is the name that customers see when purchasing your products. Please choose carefully.

Please describe something about your company and what you sell. *

Display this description in your public vendor profile (Can be edited later)

What to Expect Next

Once you submit the registration form, you will receive an email verification from healsbridge.com. Once your registration is approved, you will receive a second email with links to sign in to your new account and set up your practice and personal profile.

Our Get Started Guide will guide you through setting up your practice/store and adding products/services for sale.