Practice Information

Name of Practice *

Name of Practitioner *

Credentials (Ex. MD, DO, DC, RD, NP, etc.)

Medical License Number

Contact Person

Contact First Name *

Contact Last Name *

Address

Street Address *

Street Address Line 2

City *

State / Province *

Postal / Zip Code *

Contact Information

Phone Number *

Email *

Do You Have an Existing Account? Have you ordered Professional Products from HumanN (or previously, Neogenis Medical) in the past via phone, fax, email, or at an event? *

Yes, I have submitted forms and created an account with HumanN Medical before.
No, I have never ordered or created an exclusive medical resellers account.

How did you hear about us?

Internet Reseller Policy Confirmation

You must read and agree to the HumanN Internet Reseller Agreement. Download now before we can activate your account. By checking the box below, you are stating that you have read and agree to adhere to HumanN's Internet Reseller Policy.

I agree to Terms & Conditions *

Uploads

Upload your Medical License and Tax ID Document here:

Choose file or drag here

Thank You For Submitting Your Application!

We're delighted to have you apply for access to our HumanN Professional-grade medical supplements at wholesale prices. Your dedication to enhancing health and wellness aligns perfectly with our mission.

Here's What to Expect Next:

1. Quick Review: Your application is in good hands. We aim to review your submissions within 24 to 48 hours.

2. Account Activation: Upon approval, you'll receive an email with steps to activate your Professional account. This will grant you full access to our exclusive wholesale catalog and pricing.

3. Eager to Get Started? If you wish to make a purchase while your application is pending, please email us at professional@humann.com with the list of products and desired quantities. We're here to accommodate your needs.

4. For any questions or further assistance, our support team is readily available at professional@humann.com.

Thank you for choosing HumanN Medical. We look forward to supporting your practice with our top-tier supplements and dedicated service.

Warmest regards,

HumanN Medical team

Neo40 Professional (60 count)

N-O Indicator Strips

glyNOcalyx™