Registration request for Health Professionals

Please register to access the Health Professional area

New clients must request registration before being able to access the full online order area. Health Professionals can access the online order area. Please provide your personal and company data. Your data will be verified and you will then receive an e-mail confirmation. For unlisted countries, please contact our Commercial Staff 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 only allow online 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 as soon as possible.

Phone*

E-mail*

Password*

(must be 8 characters or more)

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

I agree

Security check*

This control helps us to reduce Spam, thank you!

This field should be left blank

Please register to access the Health Professional area

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