Practitioner Application - Spectrum Supplements

We work together with Healthcare Professionals all across the country supporting patients with their supplement needs. Whether you wish to purchase wholesale or refer your patients to our website, we can tailor a program specifically for you. We also drop-ship orders directly to your patients eliminating the need for you to handle any products.

PLEASE REGISTER AN ACCOUNT AND THEN SUBMIT THE FORM BELOW.

We look forward to working with you.

Name*
Prefix First Last
Your Username (used to register your account)*

If you did not register an account you must first do so at https://www.spectrumsupplements.ca/my-account
Phone*
Office Phone
Email*
Name of your Practice
Website (if applicable)
Business type*
- Sole Proprietorship
- Partnership (Gen, LTD, LLC)
- Corporation
Brands and/or products of interest (include those not found on website)
Authorized Signature*

Type your legal name to sign the document.
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