The safe, effective use of nutritional supplements requires careful consideration of medical history, current medications, lab tests and family history. Theralogix supplements are recommended for use under the supervision of a health care provider. Once you've registered as a Theralogix provider, you'll receive supplement samples for patient distribution, professional resource materials, and patient education brochures. We will provide you with updates listing the names of those patients in your practice that are currently receiving a Theralogix supplement, clearly identifying which formulation they are receiving. If you would like to become a Theralogix provider, simply fill out the contact information below, and a Theralogix representative will contact you. Or, to contact a Theralogix representative directly, call toll free 1-888-899-3899, from 9 AM to 4 PM, EST. Salutation: Choose One... Dr. Mr. Mrs. Ms. Provider's First Name: Provider's Last Name: Professional Degree: Choose One... M.D. or D.O. P.A. N.P. R.D. N.D. Practice Name: Practice Specialty: Choose One... Urology Primary Care Internal Medicine Other Theralogix products are designed primarily for urologists and the treatment of their patients. Some of our products are of interest to non-urologists. If your specialty is not urology, please choose the products you would like to recommend to your patients. To select more than one product, hold down your control (Ctrl) key while clicking. Prostate 2.2 Prostate SR TheraCran TherOmega TherLithXR Bladder 2.1 Fertility for Men Office Address: (Street address, PO Box)   (Apartment, suite, unit, building, floor, etc.) City: State: Choose One... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: E-mail Address: Office Phone: Fax Number: Office Manager's Name:
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