Practitioner Registration

This form is intended for use by holistic practitioners. To request access, please complete the registration below. Unless otherwise noted, all fields are required.

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Before granting you access to our site, you must submit a copy of your professional OR business license so that we can verify your status as a holistic practitioner. You may fax a copy to (475) 289-3899, email it to, or upload it below.
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By proceeding with registration on this site, you affirm a) that you are a holistic practitioner, b) that all information provided above is truthful and accurate, and c) that you agree to our terms of use.
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