Practitioner Registration

If you are a qualified health care practitioner complete the form to create your practitioner account here at Mediscan.

Practitioner details

Practitioner details are used for processing patient samples and producing reports. The postal address is used for distribution of sample collection supplies. The email address is used for distribution of reports.

Practitioner Qualifications

Please complete either Section A or Section B

Section A

I am a government registered health care professional

Section b

I am a current financial member of a government approved association

Sample Collection Supplies

Supplies will be sent to the postal address given above. Additional supplies can be ordered from Mediscan by phone, fax or using the form available once you have logged in.

Sample envelope
* Envelope for hair sample, has patient details form on envelope
Delivery envelope
* Pre-addressed outer envelope for sending hair sample envelope by mail
Referral form
* Referral form for a saliva hormone test
Sample tube
* Sample tube for saliva sample, with one biohazard bag
Four sample tubes
* Four sample tubes for saliva samples, with one biohazard bag
Bulk sample tubes
* Bulk tubes for saliva samples

Sample Collection Supplies

Supplies will be sent to the postal address given above. Additional supplies can be ordered from Mediscan by phone, fax or using the form available once you have logged in.

Security Question

Declaration

By submitting this form I declare that the information supplied above is true and correct and I will maintain the registration or membership stated above as a condition of access to this site