Gaia Professionals | Create Account

Create an Account

Welcome!

Healthcare professionals who create a website account with us are able to order online and access a wealth of information not available to the general public. A website account will grant access to past webinars on various health topics related to botanical support, Herb Med Pro, and other information specific to practitioners.

Practitioners, need an account?

Please allow 1-2 business days for our team to review your credentials.

If you need assistance, please contact [email protected].

* = required field

Practitioners Details

First Name *

Last Name *

Email Address *

Practitioner Type *

Practice Name *

Billing Address

Address Line 1 *

Address Line 2

Address Line 3

Country *

State/Province *

City *

Postal Code *

Use same address for Shipping

Other Details

Country Extension Code

Phone Number *

Tax ID/EIN

Note:This information is required for wholesale accounts

All other business names (DBA)

Upload Practitioner Credentials *

Choose File

Note:To activate your account, please upload your credentials or send it on our email

Upload Tax Resale Certificate

Choose File

Note:Tax will be applicable on your purchases if tax certificate is not uploaded

How do you get herbs or supplements to patients? *

Do you currently sell Gaia Herbs products? *

School Attended? *

If you attend conferences, please list them here.

How did you learn about us? *

Receive emails regarding new research, published articles, new products, or conferences/lectures?

Email Me

An email confirmation will be sent to you once your application has been approved.After you click “Submit”, you will be asked to send in your accredation (email/fax). All the details will be emailed to you.By submitting this application, you agree to the

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