Onboarding Documentation

Welcome to the Regen Practice Solutions Platform—we’re excited to have you on board.

This onboarding form is designed to help us gather the key information needed to set up your clinic for success. By completing the sections below, you’ll enable our team to properly configure your account, align your programs, and ensure a smooth, efficient launch.

Please complete each section as thoroughly as possible. Our team will use this information to guide your setup, support your staff, and help you begin implementing peptide protocols and patient programs with confidence.

PRACTICE INFORMATION

Practice Name Primary Practice Speciality NPI Number Supervising Provider / Medical Director Name Professional Title (MD, DO, NP, PA, etc.) License Number & State Issued Address Address Line 2 CityState

Zip

Practice Phone

Practice Email

Website URL

Schedule Appointment URL

Facebook URL

Google URL

Medical Services Provided Upload Practice Logo

Drop files here or

I certify the above information is accurate and current.

Agree

Name

Date

BILLING INFORMATION

Contact Name Title Email PhoneCard Number

Exp Date

CVV

Billing Address Billing Address Line 2 CityState

Zip

I authorize Regen Practice Solutions to charge the payment method provided for monthly invoices.

Agree

Name

Date

ACKNOWLEDGEMENT & COMPLIANCE CONFIRMATION

I acknowledge that all peptide, biologic, or regenerative products supplied by Regen Practice Solutions are provided exclusively for use by licensed medical professionals within their scope of practice.

I understand that:

I am solely responsible for safe storage, handling, and administration of all products.
I will follow all federal, state, and local regulations regarding storage and use.
I accept all liability for clinical decisions, dosing, patient selection, and outcomes.
Regen Practice Solutions does not diagnose, treat, or advise patients.
No warranties—express or implied—are provided regarding product performance or outcomes.

Agree

By signing below, I confirm that I understand and accept full responsibility for product handling, clinical use, patient outcomes, and adherence to all applicable laws and standards.

Name

Title

Date