• OVERVIEW
  • PRACTITIONER BEWARE
  • NEEDLE & CLINIC SUPPLIES
  • HERB COMPANIES WE REPRESENT
  • EMERGING MODALITIES
  • LASERS
  • BOOKS AND MEDIA
  • FOR STUDENTS: DORIS SWEETNAM SCHOLARSHIP
  • PRACTITIONER RESOURCES
  • REGISTRATION FORM
REGISTRATION FORM
Eastern Currents Distributing specializes in supplying acupuncture supplies and high quality herbal medicines to healthcare practitioners across Canada.
If you are an acupuncturist, TCM practitioner, healthcare practitioner or healthcare student and are interested in purchasing product at special practitioner pricing from from us, please complete our Professional Registration Form below.

As the majority of our products are only for use/to be prescribed by healthcare practitioners, we have established this qualifying procedure. This procedure ensures that our products and services are directed only to qualified healthcare practitioners.
 
Please note: It may take us one to two business days to verify your qualifications. Upon completion we will contact you via email with your customer number and login information for our webstore.
 
Thank you for your interest - we look forward to supporting your growing practice!

Tell us about you

First name
Last name
Home address
City
Province / State
Postal code
Business phone
Cell phone
Email address
I am currently a student
I am a professional

If you are a healthcare practitioner, please note you will be required to submit a copy of your license or certification. We will contact you for this information as we process your registration.

Type of health care practitioner
AcupuncturistChiropractor
DentistDr. TCM
HerbalistPhysiotherapist
Massage therapistMedical doctor
NaturopathNurse
Shiatsu therapistTCM herbalist
TCM practitionerVeterinarian
Other (if not listed above)
Professional title
School of graduation
Year of graduation
License number
Type of program
Acupuncture Herbalism
TCM Other
If other, please specify

Tell us about your practice

Clinical modalities used
AcupunctureElectro stim
HerbsLasers
Vitamins and supplements
Clinic name
Clinic address
City
Province / State
Postal code
Business phone
Fax number

Shipping information

Ship to
my home address my clinic address
Special shipping instructions

Billing information

Bill to
my home address my clinic address

Comments / Questions

How did you hear about us? (Optional)
Friend/ColleagueSearch engine
Print advertisementTrade show/Seminar
Link from other websiteOther (please specify)
Other (if not listed above)
Additional information or questions

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