Professional Enrollment to Offer Dental Stem Cell Banking

1. Login Information
2. Account Information
3. Confirmation and Account Summary

Login Information

Note: * - Required Fields

Email*

Password*

Password must contain at least: 1 Uppercase, 1 lowercase, 1 Number, 1 Special Character and be at least 8 characters

Confirm password*

Note: * - Required Fields

Account Information

Title

First Name*

Middle Name / Initial

Last Name*

Suffix*

Field of Dentistry*

Dental School You Attended*

Graduation Year*

License Number*

Country*

Licensing State/Province*

Primary Practice Information

Name of Practice*

Practice Phone Number*

Practice Fax Number*

Web Address

Practice Address1*

Practice Address2

Country*

City*

State / Province*

Zip/Postal Code*

Primary Practice Point of Contact (POC)

Check here if you will be serving as the Point of Contact

First Name*

Last Name*

POC Phone*

POC: Email (username)*

Password*

Password must contain at least: 1 Uppercase,
1 lowercase, 1 Number, 1 Special Character and
be at least 8 characters

Re enter Password*

Occupation/ Practice Title*

Administrative Fee

Administrative Fee Payment Options

Mail the Check

PayPal

Mail the check to this Address

Name of payee*

Address1*

Address2

Country*

City*

State / Province*

Zip / Postal Code*

PayPal Account Name*

Email*

Phone*

Terms Of Service

I agree to the terms and conditions

Login Details

User Name

Password

Account holder

Title

First Name

Middle Name

Last Name

Suffix

Field of Dentistry

Dental School you attended

Graduation Year

License Number

Licensing Country

Licensing State/Province

Coupon Code

Practice Information

Administrative fee

Administrative Fee

Not Selected

Administrative Fee Type

Name of payee

Address1

Address2

Country

City

State/Province

Zip/Postal Code

PayPal Account Name

Phone

Yes – Please send me StemSave’s monthly Newsletter with the latest stem cell news and info

THANK YOU FOR ENROLLING AS A STEMSAVE™ DENTAL PROFESSIONAL

BELOW ARE THE DETAILS FOR YOUR TRANSACTION

StemSave Advantage Benefits Package

Quantity

Welcome to the StemSave Provider Network. Your practice is now at the forefront of stem cell science and regenerative medicine.

In a few days, you will receive your StemSave Provider Starter Package which includes:

Patient brochures and holder
Educational poster for your waiting or treatment area
Provider Reference Guide with information on our Transport Kit, EZ Ship Protocol, Talking Points, and Tooth Eligibility Criteria
Our patented StemSave Transport Kit which makes it possible for you to always be prepared to offer stem cell banking to your patients

Start enjoying your StemSave Advantage Benefits today:

Fully-Automated, Paperless, Seamless Practice Integration
Professional Courtesy Discount on Stem Cell Banking for You and Your Family
Practice Marketing Tools
Incremental Practice Revenue

You will receive an email with transaction details along with information on The StemSave Advantage Benefits Package. Please feel free to contact one of our dedicated service specialists at any time with questions or suggestions at 877.StemSave (877.783.6728).

Once again, we welcome you and thank you for joining the largest and fastest growing stem cell banking network dedicated to Saving Cells for Life.

Sincerely,

Arthur Greco, CEO

THANK YOU FOR ENROLLING AS A STEMSAVE™ DENTAL PROFESSIONAL

Welcome to the StemSave Provider Network. Your practice is now at the forefront of stem cell science and regenerative medicine.

In a few days, you will receive your StemSave Provider Starter Package which includes:

Patient brochures and holder
Educational poster for your waiting or treatment area
Provider Reference Guide with information on our Transport Kit, EZ Ship Protocol, Talking Points, and Tooth Eligibility Criteria
Our patented StemSave Transport Kit which makes it possible for you to always be prepared to offer stem cell banking to your patients

Start enjoying your StemSave Advantage Benefits today:

Fully-Automated, Paperless, Seamless Practice Integration
Professional Courtesy Discount on Stem Cell Banking for You and Your Family
Practice Marketing Tools
Incremental Practice Revenue

Once again, we welcome you and thank you for joining the largest and fastest growing stem cell banking network dedicated to Saving Cells for Life.

Sincerely,

Arthur Greco, CEO

Dental Practice Enrollment with StemSave