Skip to main content
facebook
linkedin
541-777-3356
My Account
Hit enter to search or ESC to close
Close Search
0
Menu
Team
Testimonials
Seminars
Fundamentals, March2023
PAIN AND ADDICTION
BUSINESS: FINANCE & MARKETING
Fundamentals, June 2023
NAD & Emergency Medicine
Business: Operations & Optimization
IV ONLINE SUMMIT
Fundamentals, September 2023
Online Courses
Heavy Metal Toxicology, From A-Z
Video Seminar – Advanced IV Therapy Strategies Nov. 2018
Consults
3 Day Power
2 Day Express
1 Day Consultation
Hourly Consult : The Business of Health Remote
Hourly Consultations Terms & Conditions
IIVNTP Library
What is IV Nutritional Therapy
Resources
Clinical Applications and Advanced Topics of IV Therapies in Oncology
Sponsors
Blog
Contact Us
0
Cart
Close Cart
IV Micronutrient Therapy Group Intake Form
IVMT Groups.io Intake Form
If you were a part of the IVMT Yahoo Group, you do not need to fill this out again as you have already been vetted.
If you have any questions, please reach out to IVMT+owner@groups.io
1. Your full name with post-nominal letters.
*
First
Last
post-nominal letters
Email
*
2. The medical school you went to AND the year you graduated.
*
If you are a student, include your anticipated graduation date
3. The state you are licensed in AND your license number.
*
If you are a student, state you are a student.
4. Your specific educational credentials in IV micronutrient therapy, including when, where, and from whom. Note: this means formal CME / CE approved education.
*
5. IF YOU ARE NOT A LICENSED PRESCRIBER (or student), provide the name of the prescriber member under whom you carry out orders.
Please upload a scanned copy of your license
*
Max. file size: 50 MB.
Comments
This field is for validation purposes and should be left unchanged.
Join Our Newsletter
Get the latest news and seminars dates delivered via email!
"
*
" indicates required fields
Name
*
First
Email
*
I agree
*
I agree to receive marketing news and updates.
Close Menu
Team
Testimonials
Seminars
Fundamentals, March2023
PAIN AND ADDICTION
BUSINESS: FINANCE & MARKETING
Fundamentals, June 2023
NAD & Emergency Medicine
Business: Operations & Optimization
IV ONLINE SUMMIT
Fundamentals, September 2023
Online Courses
Heavy Metal Toxicology, From A-Z
Video Seminar – Advanced IV Therapy Strategies Nov. 2018
Consults
3 Day Power
2 Day Express
1 Day Consultation
Hourly Consult : The Business of Health Remote
Hourly Consultations Terms & Conditions
IIVNTP Library
What is IV Nutritional Therapy
Resources
Clinical Applications and Advanced Topics of IV Therapies in Oncology
Sponsors
Blog
Contact Us
541-777-3356
My Account
facebook
linkedin