Join the Medical Alliance Network

Registration

Join the Medical Alliance Network (free)

MediPro Direct
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Join the Medical Alliance Network

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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?*