Welcome

To request an account, please provide the following information:

Clinic
Information
Prescriber
Information
Communication
Preferences
Review
& Submit

Clinic Information

Clinic Name:

*Please check this box if you are a Biote certified prescriber

*Please check this box if your practice offers telehealth services

Clinic Phone:

Website:

Billing Street Address:

City:

State:

Zip Code:

Copy Shipping address from billing address.

Shipping Address:

City:

State:

Zip Code:

*No of Providers:

*No of Non-Provider Employees:

*No of Patients:

*No of Locations:

Name of best office contact:

Contact's Position:

Contact's Email:

Clinic Account User Name:

Clinic Account Password:

Confirm Password:

Prescriber Information

*Please fill out the following information for each prescriber. If you do not have all of the information at this time, you may add additional prescribers later through your online portal.

Prescriber Credentials: *

First Name: *

Last Name: *

Email: *

Cell Phone: *

NPI:

DEA:

U.S. Medical License *

License State *

*If the prescriber is licensed in more than one state, please provide all license number and corresponding states.

Add additional US license

Make Primary Prescriber :

Prescriber User Name:

Prescriber Password:

Confirm Password:

Prescriber Credentials: *

First Name: *

Last Name: *

Email: *

Cell Phone: *

NPI:

DEA:

U.S. Medical License *

License State *

*If the prescriber is licensed in more than one state, please provide all license number and corresponding states.

Add additional US license

Make Primary Prescriber :

Prescriber User Name:

Prescriber Password:

Confirm Password:

Delete

Prescriber Credentials: *

First Name: *

Last Name: *

Email: *

Cell Phone: *

NPI:

DEA:

U.S. Medical License *

License State *

*If the prescriber is licensed in more than one state, please provide all license number and corresponding states.

Add additional US license

Make Primary Prescriber :

Prescriber User Name:

Prescriber Password:

Confirm Password:

Delete

Prescriber Credentials: *

First Name: *

Last Name: *

Email: *

Cell Phone: *

NPI:

DEA:

U.S. Medical License *

License State *

*If the prescriber is licensed in more than one state, please provide all license number and corresponding states.

Add additional US license

Make Primary Prescriber :

Prescriber User Name:

Prescriber Password:

Confirm Password:

Delete

Review & Submit

Please review the information entered before submitting your account request.

CLINIC INFORMATION

Clinic Name:

Your practice is related to Biote:

Your practice offers telehealth services:

Website:

No of Providers:

No of Non-Provider Employees:

No of Patients:

No of Locations:

Clinic Phone:

Billing Street Address:

City:

State:

Zip Code:

Shipping Address:

City:

State:

Zip Code:

Best Office Contact Name:

Contact's Position:

Email:

Clinic User Name:

Clinic Password:

PRESCRIBER INFORMATION

Prescriber Credentials:

First Name:

Last Name:

Email:

Prescriber User Name:

Prescriber Password:

Cell Phone:

NPI:

DEA:

Primary Prescriber:

U.S Medical License:

License State:

COMMUNICATION PREFERENCES

Order Notification:

Notification Emails:

Notification Stages:

Bill Prescriptions To:

Ship Prescriptions To:

Welcome

Clinic Information

Prescriber Information

Communication Preferences

Our clinic would like for prescriptions to be handled as marked below:

Review & Submit

CLINIC INFORMATION

PRESCRIBER INFORMATION

COMMUNICATION PREFERENCES