Doctor account application

Because the Microbiome Center's recipe consists of a magistral preparation under the Medicines Act, we must ensure that prescriptions are only written by BIG-registered doctors. For this reason, we have to check every registration in the BIG register.

Name

This field is for validation purposes and should be left unchanged.

First name(Required)

Last name(Required)

Email address(Required)

Phone number

Date of birth (DD/MM/JJJJ)(Required)

Practice address(Required)

Body of registration(Required)

Biovis customer number (if available)

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Doctor account application

For healthcare providers

General