Practitioner Registration Form

Revealing the Complete Picture
Uncover powerful insights into the root cause of illness with simplified, science-driven testing. Partner with Biometrix Labs and provide your patients with cutting-edge diagnostic solutions that go beyond traditional testing.

As an affiliate partner, you’ll not only enhance patient care but also earn a percentage of every test you sell. No extra workload—just seamless integration into your practice, providing deeper insights and better outcomes.

💡 Join us today and take your patient care to the next level.

👉 Become a Biometrix Partner Now

New PractitionerUpdate to Existing Practitioner

Your Name (required)

Credentials

Date

Clinic

Address

Phone (required)

Fax

Practitioner Email (required)

Website

Social Media Links

Practice Emphasis

Qualification

Institution where qualification was obtained

Qualification Year

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

Referred byInstitute of Integrative MedicineEmailWeb SearchConference / EventOther

If Conference, please fill in:
Conference / Event Name

If Referred, please fill in:
Referred by (please specify)

If Other, please fill in:
Other (Please specify)

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
Preferred email address for reports (required)

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

Subject

Any Further Details

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I consent to the conditions.