Vendor Registration

Username*

Email*

First Name

Last Name

Address 1*

Address 2

Country*

City/Town

State/County

Postcode/Zip*

Store Phone*

APD Registration Number

Do you confirm that you are covered by professional indemnity insurance*

Do you offer Home Visits?*

Do you offer Telehealth*

Do you Offer In Clinic Services*

Do you offer Bulk Billing?*

Are you a DVA Provider?*

Are you an Accredited Sports Dietitian*

Are you a Registered Medicare Provider*

Are you a registered NDIS provider*

Are you a Credentialed Diabetes Educator*

Are you an Accredited Exercise Physiologist*

Upload Official Accredited Practicing Dietitian (APD) Logo

Which Video Conferencing do you use?

Password*

Confirm Password*