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Please upload a copy of your Healthcare Provider License

NeuroScience products are taxable in some states. I acknowledge that I am registered with my state to purchase products from NeuroScience with sales tax exempt status. I will complete the documentation that is sent to me so that I will not be charged sales tax when I order products from NeuroScience.

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Once your application is processed, you will receive an email to acknowledge and sign the NeuroScience Terms and Conditions, Product Resale Agreement, and MAP policy via DocuSign.

Please fill out all required fields before submitting your application.

If you need assistance getting started, call (888) 342-7272 or email newaccounts@neurorelief.com