Professional Provider Application – Fax

Thank you for choosing SafeCareRx. Our simple process for sign-up involves three easy steps:

1. Download the Professional Provider Application:
Microsoft Word (docx format) -or- Adobe Acrobat (pdf format)

2. Fill out the application

3. Fax the application, along with a copy of your professional license, diploma, or certification from your health profession (nurse, chiropractor, acupuncturist, medical doctor, massage therapist, or alternative/integrative health practitioner) to:

Attention: Marie
FAX: 828-225-5542

Alternately, you can scan and email your application and license or certification to procsr@safecarerx.com

Note: We don’t require a state reseller’s license for Professional accounts but will need assurance that your account will be used in compliance with our Right to Distribute, which you will receive at the time of sign-up.

Our professional Customer Service Representatives are available to answer questions you may have regarding sign-up, products and pricing, seminars, test kits and more.

Call 866.298.2740 or email procsr@safecarerx.com for more information.

Welcome to SafeCareRx!

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