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Open A Healthcare Professional Account

Simply fill out the form below to open a Cyrex Laboratories healthcare professional account. Your information will be reviewed by Customer Service within 1-2 business days. If you are a healthcare professional outside of the United States, Canada, US Territories, Ireland or the United Kingdom, Contact Us to learn more.
* = required field

1 Personal Information

Country: *

First Name: *

Last Name: *

Phone: *

Fax:

Personal NPI#:* What's This?

Email: * (This will be your username)

Password: * (Retain for login) Must be at least 8 characters in length and contain at least 1 numeric character, 1 uppercase and lowercase character, and 1 special character such as !@#$%^&*(){}[]

Confirm Password: *

2 Business Information

Business Name:

Specialty: *

Street: *

Unit:

City: *

State: *

Zip Code: *

Please help us. How did you hear about Cyrex Labs?*

3 Licensure

License Type: *

License State: *

License #: *

Issuing Board: *

I certify that my license listed above is: a) current and active, b) free from current disciplinary action, c) granted in the State in which I practice, and d) provides authority to order testing offered by Cyrex Laboratories. Furthermore, I certify that patients for whom I order Cyrex testing are under my direct care and supervision or that of another licensed medical professional in my practice.

Cyrex's Provider Directory

I want to be included

I DO NOT want to be included

Being listed in the Directory or information being disclosed to others does not constitute an endorsement, affiliation, sponsorship or recommendation of the provider or his/her services by Cyrex. Cyrex is under no obligation or requirement to divulge that information in part or in whole to a prospective user and any information so disclosed is at the sole discretion of Cyrex. Moreover, Cyrex will not provide the information of the prospective user to any provider listed in the directory.

I promise under penalty of perjury that the information on this form is correct to the best of my knowledge.

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