Doctor Registration

We are excited to welcome you to our group of medical professionals. We look forward to supplying you and your patients with the very best CBD products. Please fill out this quick application, which will be used to register your account and be processed within 24 hours. You will notified by email of your account’s status immediately after reviewed.

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Business or Practice Name^*
Enter name exactly as it appears on your Federal Tax Forms
TIN or EIN^*
Federal Tax Identification Number (TIN), or Employer Identification Number (EIN)
First Name^*
Last Name^*
Email^*
Phone
Please enter a phone number we can reach you with for verification if necessary.
How did you hear about us?
Please select the option that fits you best, or you can select "Other"
Username^*
Password^*
Password must be at least 7 characters long.
Enter password again^*
Password must be at least 7 characters long.
Unique Referral Code^*
Given to your patients so they can purchase through our patient portal. Your referral code can be six characters long, and can contain numbers and letters only.

Doctor Registration

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