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PATIENT ACCOUNT

Step 1: Obtain your patient ordering referral code.

To create a patient ordering account, you must first obtain a patient ordering referral code from your practitioner.

Step 2: Complete patient ordering application.

Please complete the form below. You will receive an email once your application is received. Please follow the directions of that email to complete your account application process. Your practitioner will also be notified of your account application.

If you have any questions, please do not hesitate to contact us

Note! Note: All fields marked with * are mandatory.

General Account Details

Please make sure your password is either at least 16 characters long (I.E a sentence or phrase) OR is 8 to 15 characters in length made up of a combination of three types of characters being either uppercase or lowercase letters, numbers or symbols.

  4. Confirmation password does not match password

Terms and Agreement

I/We have read and agree to the Terms & Conditions of sale, the Retail Policy and the Privacy Policy, and: I/We hereby authorise FIT-BioCeuticals Pty Ltd. to make any enquiries or disclose any information concerning my/our credit worthiness to any person or source as considered appropriate by FIT-BioCeuticals Pty Ltd. If granted credit, I/We agree to comply with and be bound by the Terms and Conditions (as amended from time to time). My/Our financial situation is satisfactory and I/We can meet all financial obligations. There are no lawsuits against me/us at this present time. I/We make an application for an account for the purpose of obtaining merchandise from FIT-BioCeuticals Pty Ltd.

I/We have read and agree to the Terms & Conditions of sale, the Retail Policy, the Privacy Policy, and the Clinical Supply & Sale Policy, and: I/We hereby authorise FIT-BioCeuticals Pty Ltd. to make any enquiries or disclose any information concerning my/our credit worthiness to any person or source as considered appropriate by FIT-BioCeuticals Pty Ltd. If granted credit, I/We agree to comply with and be bound by the Terms & Conditions (as amended from time to time). My/Our financial situation is satisfactory and I/We can meet all financial obligations. There are no lawsuits against me/us at this present time. I/We make an application for an account for the purpose of obtaining merchandise from FIT-BioCeuticals Pty Ltd.