Practitioner Registration Form

    New PractitionerUpdate to Existing Practitioner

    How did you hear from us? (Please select one)

    Referred byInstitute of Integrative MedicineEmailWeb SearchConference / EventOther

    If Conference, please fill in:

    If Referred, please fill in:

    If Other, please fill in:

    Become a Functional Medical Practitioner

    Use this discount coupon code: biometrix while checking out, and you will receive a 10% discount on your purchase.

    Apply here: www.iim.health/ref/biometrix/

    Reporting
    Biometrix Labs sends report results directly to the Practitioner's

    Billing
    Patients pay Biometrix Labs directly or Biometrix Labs can bill the practice

    I consent to the processing of my personal information under the "Protection of Personal Information Act, 2013 (POPI)" in line with Our Privacy Policy