Practitioner Registration Doctor Sign-up First Name * Last Name * Email * Address Line 1 * Address Line 2 City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Discipline * ND (Naturopathic Doctor) MD PhD Pharmacy DDS/DMD DO (Doctor of Osteopathy) DC (Doctor of Chiropractic) LAC (Licensed Acupuncture Therapist) Other Facility or Business Name * School Speciality Allergy/ Immunology Ayurvedic Cardiology Environmental Medicine Dermatology Family Medicine Geriatrics Holistic Medicine Homeopathy Internal Medicine Neurology Oncology Ophthalmology Oriental Medicine Orthodaedic Other Pediatrics Plastic Surgery Preventive Medicine Psychiatry Psychology Sports Medicine Surgery Weightloss / Bariatrics Women's Health EIN / SSN Used for tax reporting on doctor income earned when patients order directly through Tesseract using their Practitioner's Code. Certification Acupuncturist Adv. Reg. Nurse Practitioner Certified Clinical Nutritionist Certified Nutritional Consultan Certified Nutritional Specialist Certified Personal Trainer Chiropractor Dentist Doctor of Oriental Medicine Doctor of Pharmacy FF PLAN Health Coach Herbalist Holistic Practitioner Homeopath Hospital Licensed Massage Therapist Licensed Mental Health Counselor Licensed Midwife Licensed Practical Nurse Licensed Therapist Marriage & Family Therapist Masters of Science Medical Doctor Naprapath Naturopathic Doctor Nurse Practitioner Nutritionist Occupational Therapist Optometrist Orthodontist Osteopath Pharmacy Ph.D. Physical Therapist Physicians Assistant Podiatrist Psychologist Radiological Technologist Registered Dental Hygienist Registered Dietician Registered Nurse Registered Pharmacist Sales Rep Student-DC Student-DO Student-DVM Student-LAC Student-MD Student-ND Student-Medical School Veterinarian Veterinarian Technicians Practitioner License / Certificate Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Ex: Clear scan, photo, or digital copy Practitioner License / Certificate Number * Accelerates account approval Will you be reselling Tesseract products to your patients? * Yes No Reseller Tax ID State Issued Resell Tax Certificate Drop a file here or click to upload Choose File Maximum upload size: 134.22MB I would like to participate in future product trials by providing feedback on patient results on new or pre-release products. Yes If you are human, leave this field blank.