New Practitioner Registration

Health practitioners who see patients may register with Uriel to receive a price discount. Please email, call or fax your orders. Our apologies: At this time, Uriel’s webstore cannot accept this discount. You may leave an order via email or voicemail 24 hours a day: orders@urielpharmacy.com or 1.866.642.2858, ext. 1.

To register, you need to complete all the requested information below and send a copy of your practitioner's license to our fax number or mailing address. We will email you once your registration has been approved.

Title	- Select -MrMissMsMrsDrProf
Firstname
Lastname
Suffix	- Select -CMTDCDDSDlHomDODPMDVMFNCFMFNPLAcLMTMDNDNMDNPODOTPAPhDPTRDRMTRNRNP
Email
Password
Clinic
Clinic Address	Street Address City State Zip Code Country
Phone
Web Site
Type of Practice
Education
License	Are you a licensed Practitioner? Yes    No If yes, please complete: License Number Issuing State Issuing Country
Years in Practice
Years Using Uriel  Remedies
Resources	I would like to receive Uriel's periodic email newsletter for practitioners. Yes    No
	I would like to receive Uriel's professional pricelist and other materials via mail at the address above. Yes    No