Wholesale Register

Apply as a wholesaler

Are you interested in offering our products to your clients and customers? Please tell us about yourself and we will be in touch ASAP!

Practitioner / Owner Name(Required)

Prefix First Last

Company Name

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Practitioner Specialty(Required)

How did you hear about us?(Required)

I heard about you another way, from...

Please upload your credentials and Reseller License if applicable

If you don't have these handy, we can get them from you later. You may also email files to wholesale@heuristichealing.com.

Drop files here or

Accepted file types: pdf, jpg, png, gif, Max. file size: 10 MB.

Your comments, questions, or anything you'd like to add?