Application | Deseret Biologicals

Deseret Biologicals New Account Application

DesBio sells to certified healthcare professionals only. To register for a new account with DesBio, please complete the online application below.
Name*
First Last
Company Name
Date*
MM slash DD slash YYYY
Office Phone*
Mobile Phone
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Password
Enter Password Confirm Password

How did you hear about DesBio?*
Who referred you?
If other, please list:
Website
Social Media Handle(s)
Are you a STUDENT or PRACTITIONER?*
- Practitioner
- Student
How many practitioners are in your practice?*
Primary Specialty (choose one)*
If other, please list:
How many years have you been practicing?*
To whom are you primarily planning to administer our products?*
If other, please list:
What product line(s) are you interested in?
- hA2cg Weight Loss
- OmniCleanse/Detox
- Chronic Infections/SSR
- Homeopathics
- Liposomals
- Other
If other, please list:

Upload License/Certificate OR Student ID

MUST BE A CURRENT LICENSE / CERTIFICATE
Expiration Date?
Month
Day
Year
Type of License/Certification?*
Upload License/Certificate or Student ID Here*

Drop files here or

Max. file size: 50 MB.
Required: If you are a practitioner, please upload a valid healthcare practitioner license or certificate that includes your name. If you are a student, please upload a valid student ID from a relevant college or university that includes your name. If you have questions please contact us at [email protected]

Deseret Biologicals Internet Sales Policy:*
- I agree to abide by Deseret Biologicals’ policy on internet sales that no Deseret Biologicals product should be sold to the consumer without first providing a healthcare evaluation/consultation from a qualified healthcare professional. I will in no way allow customers to purchase Deseret Biologicals product from my website or any other website without first consulting directly with my patient/customer. I further agree that I will not resell any products that I purchase from Deseret Biologicals to anyone other than my own personal customers. I understand that I will be fully responsible for any and all costs that Deseret Biologicals incurs as a result of my breach of this agreement as well as a minimum payment of $5000 per infraction.
Date*
MM slash DD slash YYYY
Deseret Biologicals Internet Sales Policy Signature*
Deseret Biologicals Internet Sales Policy: I agree to abide by Deseret Biologicals’ policy on internet sales that no Deseret Biologicals product should be sold to the consumer without first providing a healthcare evaluation/consultation from a qualified healthcare professional. I will in no way allow customers to purchase Deseret Biologicals product from my website or any other website without first consulting directly with my patient/customer. I further agree that I will not resell any products that I purchase from Deseret Biologicals to anyone other than my own personal customers. I understand that I will be fully responsible for any and all costs that Deseret Biologicals incurs as a result of my breach of this agreement as well as a minimum payment of $5000 per infraction.
Deseret Biologicals Return Policy:*
- I understand that as an authorized distributor of Deseret Biologicals products I can, after calling Deseret Biologicals for authorization, return unopened product in good condition to Deseret Biologicals for credit on my account within 30 days of receipt of product. I can use this merchandise credit to apply to future Deseret Biologicals purchases. I understand and agree that Deseret Biologicals does not issue refunds for product returns.
Date*
MM slash DD slash YYYY
Deseret Biologicals Return Policy Signature*
Deseret Biologicals Return Policy: I understand that as an authorized distributor of Deseret Biologicals products I can, after calling Deseret Biologicals for authorization, return unopened product in good condition to Deseret Biologicals for credit on my account within 30 days of receipt of product. I can use this merchandise credit to apply to future Deseret Biologicals purchases. I understand and agree that Deseret Biologicals does not issue refunds for product returns.
Healthcare Professional Certification:*
- I understand that the products I purchase from Deseret Biologicals (the “Products”) are complex products whose effects could vary from patient to patient. I hereby acknowledge that, as a prescribing healthcare professional, I will prescribe the Products based solely on my own professional judgement, as opposed to reliance on any claim or statement made about the Products by Deseret Biologicals, its staff or representatives.
Date*
MM slash DD slash YYYY
Healthcare Professional Certification Signature*
Healthcare Professional Certification: I understand that the products I purchase from Deseret Biologicals (the “Products”) are complex products whose effects could vary from patient to patient. I hereby acknowledge that, as a prescribing healthcare professional, I will prescribe the Products based solely on my own professional judgement, as opposed to reliance on any claim or statement made about the Products by Deseret Biologicals, its staff or representatives.
Student Product Advice Certification:*
- I understand that the products I purchase from Deseret Biologicals (the “Products”) are for my personal use only in my studies to become a healthcare practitioner. I understand and agree that I will not sell or dispense any “product” to any “patients” or the general public.
Date*
MM slash DD slash YYYY
Student Product Advice Certification Signature*
I understand that the products I purchase from Deseret Biologicals (the “Products”) are for my personal use only in my studies to become a healthcare practitioner. I understand and agree that I will not sell or dispense any “product” to any “patients” or the general public.
Product Advice Certification:*
- I understand that Deseret Biologicals sells many types of Products including homeopathic products. I certify and acknowledge that by purchasing any Product from Deseret Biologicals that I am legally and lawfully able to provide advice to my clients/patients on the use of those Products and prescribe them based on my own professional judgment, and I am solely responsible for the determination of their usage. I agree to immediately notify Deseret Biologicals and to cease the purchase of any Products if I am unable to legally and lawfully comply with this statement.
Date*
MM slash DD slash YYYY
Product Advice Certification Signature*
Product Advice Certification: I understand that Deseret Biologicals sells many types of Products including homeopathic products. I certify and acknowledge that by purchasing any Product from Deseret Biologicals that I am legally and lawfully able to provide advice to my clients/patients on the use of those Products and prescribe them based on my own professional judgment, and I am solely responsible for the determination of their usage. I agree to immediately notify Deseret Biologicals and to cease the purchase of any Products if I am unable to legally and lawfully comply with this statement.
Are you from outside of the US?*
- Yes
- No
If you are an international customer, download the Shipping International Waiver, carefully read, print, and keep in your files and also EMAIL a completed, signed copy back to us at [email protected]

Deseret Biologicals New Account Application

MUST BE A CURRENT LICENSE / CERTIFICATE

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