Account Registration – Dermatology M

Pre-Requisites forApplicants

Avicenna Centre for Chinese Medicine Ltd (dermatology-m.co.uk & avicenna.co.uk) sell to the public, to patients with prescriptions from registered practitioners and to practitioners and students of Traditional Chinese Medicine (TCM), Oriental Medicine and other licensed health professionals.

If you would like to order as a practitioner, please register your details to create a customer account in our password protected area to take advantage of volume discounts and special offers as well as custom made products.

For more information on eligibility, please see our customer statement.

Personal Details
Salutation*
Full Name*
Suffix
Email Address*
Country*
Apt #, Floor, Building, Etc.
Street*
City*
State/District*
Zip/Postal Code*
Education
Specialities*
Profession*
Qualification*
Professional Association
School*
Practice/Company
Clinic/Company Name*
Practice Type*
Credential*
License Number
Professional Association/Insurance Certificate (10MB Max)
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 10 MB.
Expiration Date*

Day
Month
Year
Country*
Phone*
Website
Account Security
Note: Password must be 8 characters or more*
Enter Password Confirm Password

Strength indicator

Note: Password must be 8 characters or more
Submission
- Your application can take up to a week to process
- You will be notified by email whether you have been successful
- A shopping account will be automatically created
Name
This field is for validation purposes and should be left unchanged.

Register for Practitioner Account

Pre-Requisites forApplicants

Personal Details

Education

Practice/Company

Account Security

Submission

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