Practitioner Account

Natura EDU offers a wealth of valuable information related to herbs and nutrients, carefully chosen for their synergistic effects and health supportive benefits. Registration will provide you with access to a massive library of educational resources and opportunities, our goal is to assist you in effectively integrating natural herbs and nutrients into your health practice. If you have questions about creating a new account, please contact Ana Shrader, Customer Service Account Manager at Natura EDU, (tel) 541.488.0210 x310 or by email.

Step 1:

Title

First Name:*

Last Name:*

Suffix

Account Email Address:*

Confirm Email Address:*

Create Password:*

Verify Password:*

Business Name:

Are you the owner?

Yes No Not Applicable

Company Website:

Address:*

Suite/Apt/Etc:

City:*

State/Province:*

Zip/Postal Code:*

Country/Apt/Etc:*

Phone 1:*

Office Cell Home

Phone 2:

Office Cell Home

Preferred Method of Contact:

Phone Email Either

Step 2:

Professional Designation – select one or more (CTRL + click to select additional professions)*

If unlisted, provide designation

In order to set up your account, we need to receive a copy of one of the following items: certification or state license.

Option 1 : Upload your certification or state license

Option 2 : Provide link to Licensing Board Website and list your License Number.

Licensing Board Website:

License Number:

Option 3 : Fax forms to 877.488.3844 or scan and email to newcustomers@naturahealthproducts.com

Is the name on your license different than listed on this application?

Yes No

If yes, what name is on your license?

By checking this box, I affirm that I have not intentionally misrepresented my professional designation.

If you are a senior student in one of the listed professions, we will consider professional status if you provide us the following information:

Name of school or institute:*

Name of program:*

Number of hours required for graduation:*

Completed hours:*

Projected date of completion:*

Educational goal:*

Products of interest:*

Do you carry other professional supplement lines?*

Yes No

Please list:

How do you plan on administering the products (friends, family, clients)?*

Please upload any proof of registration of enrollment and a letter from your school faculty member stating that you are in good standing to graduate

If these forms are not ready to be uploaded, please fax forms to 877.488.3844 or scan and email to newcustomers@naturahealthproducts.com at your convenience after submitting this application.

We consider exceptions on a case-by-case basis for healthcare practitioners in unlisted professions. Criteria is based on applicable training and experience. Please provide the following information:

What qualifies you to recommend nutritional and herbal formulas to clients?*

List your education background relating to herbs and nutrition:

Name of school or institute:*

Program/Certificate/Diploma/Degree/License earned:*

Completed Program Hours:*

Have you studied with/under other healthcare professionals?*

Yes No

If yes, list their name(s):

Would they provide a reference to your ability to recommend formulas?*

Yes No

Products of Interest:*

How do you plan on administering the products (friends, family, clients)?*

Do you carry and/or recommend other professional nutritional or herbal supplement lines?*

Yes No

If yes, please list the lines you carry (max 5):

List any other pertinent information, self-study experience etc.:

Please upload any license or certification you currently have pertaining to your ability to recommend nutritional and herbal supplements

If your forms are not ready to be uploaded, fax forms to 877.488.3844 or scan and email to newcustomers@naturahealthproducts.com at your convenience after submitting this application.

Step 3:

Please describe your practice*

Will you be reselling products outside your private practice?

Yes No Not Sure

If yes, where will they be sold?

Retail Store Online Sales Both Not Applicable

Area(s) of Focus/Interest (check all applicable):*

Adrenal/Stress Support
Animal Health
Cardiovascular Support
Detoxification/Liver Support
Mens Health
Mood Support
Cell Life Regulation
Skin Care
Vitamins/Minerals/Amino Acids/Proteins
General Wellness
Other

Allergies/Seasonal Support
Athletic Performance
Cellular Health/Antioxidant
Immune Support
Womens Health
Neurological Support
Pain/Inflammation
Sleep Support
Weight Management/Blood Sugar Support
Longevity

How did you hear about us?*

Associate
Patient
School/Class
Blog
Integrative Practitioner
Television
Other

Friend
Conference
Search Engine
Advertisement
Social Media

FacebookTwitterOther

Radio

All practitioners are required to sign our Product Distribution Agreement.Sign the Agreement

* Required Fields

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Body Walker
Certified Nutritionist
Doctor Of Chiropractic
Doctor Of Dental Surgery
Doctor Of Oriental Medicine
Doctor Of Osteopathy
Doctor Of Veterinary Medicine
Licensed Acupuncturist
Licensed Message Therapist
Licensed Midwife
Licensed Physical Therapist
Medical Doctor
Naturopathic Doctor
Nurse Practitioner
Physician Assistant
Registered Dietitian
Registered Herbalist
Registered Nurse
Registered Pharmacist
Student
Unlisted Professional