RegistrationJoin the Medical Alliance Network (free) MediPro Direct 5 Join the Medical Alliance Network ALL INFORMATION COLLECTED DURING REGISTRATION IS TRANSMITTED AND STORED SECURELY. "*" indicates required fields Name* First Name Last Name Phone*Email* Address* Street Address City State ZIP Code Do you offer mobile phlebotomy, in office phlebotomy, or both?* Miles You are Willing to Travel (if applicable):*How many phlebotomists work for you, including yourself?* List all licensure and training you have (Phleb, M/A, RN, etc.)?* How long have you been drawing blood and approximately how many blood draws have you performed in the past 12 months?* List the service channels you are experienced in and length of experience in years including: Paramedical life insurance exams (P), Clinical Trial Draws (C), Specialty Lab Draws (S), and Other (Please Specify).* What equipment do you own/use for these services (Centrifuge, EKG, etc.)?* Do you have a recent background check (6 months or less) that you can provide to us?*
