Practitioner Application Form

Thank you for your interest in a practitioner account with Uriel. Some Uriel products are considered professional products and require a licensed prescriber’s authorization to purchase. To set up a practitioner account, please fill out the form below and a member of our Customer Experience team will be in touch with next steps.

If you are not a prescribing practitioner and want to apply for a business account, click here.

Access to all products online including practitioner only products

40% off retail pricing for all products (exluding Helixor products)

20% off retail pricing for Helixor products (mistletoe and helleborus niger)

Access to order forms

Ability to dropship

Ability to graduate to VIP program

Apply Now

Practitioner First Name Practitioner Last Name

Clinic Name

Type of Prescribing Practitioner

Website

Office Phone

Email Address

Address

City

Country

State

Zip/Postal Code

Subscribe to marketing emails (optional)

Please upload your practitioner license document as a PDF or image file.