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Practitioner Signup
Email (will be your user name)
Password
User Is Enabled
Full Name
Job Title (You may select more than one title if applicable)
Street Address
City
State/Territory
ZIP
Mobile
State(s) you are licensed in
Max Number of Patients Per Week You Can Accept
Max Distance From Your Address You Can Travel for a Fitting (minimum 30 miles)
Profile Pic
Please upload a copy of your state certification. After an interview, you will be granted access to the portal, where you can download blank copies of our contract and W9 to fill and sign.
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