If you would like to be able to order products on our online store, you will need to fill out this registration form for us to set up your account for you. Once we receive this form, we will add you as a customer, and you should get an email with your username and a temporary password. To log in, you can then go to the "Patient Info" drop down menu and click on "Order Products" which will bring you to the login page. If you have any issues with logging in, or if you can't find a product on the online store that you need, please contact Rachael at (952)891-3019, or firstname.lastname@example.org. NOTE: If you do not want to order products from the online store, we can do product orders over the phone instead, in which case you would contact Rachael to place your order.