Registration request for Health Professionals

Please register to access the Health Professional area

New Clients must be request for registration before access the on-line full order area. Health Professionals can access on-line order area. Please provide your data and your Company’s data. We will check the data, you will receive email confirmation after the data will be checked. For unlisted countries, please contact our Commercial Staff at info@eptamed.com, or check the Order page.

Surname*

Name*

Company*

Professional License Number*

VAT Code*

Codice fiscale

Medical profession*

Address*

City*

Province, or State*

International post code*

Country*

We allow on-line orders only from countries listed in this form. For unlisted countries and commercial info, please contact our Commercial Staff at info@eptamed.com, we will reply soon as possible.

Phone*

E-mail*

Password*

(must be 8 characters or more)

Privacy confirmation, all data collected will be managed according the EU law (more info):*

I agree

Security check*

This control helps us to reduce Spam, thank you!

This field should be left blank