Health Care Professionals
Request Password Form
This form is for Health Care Professionals only. If you
do not want to register for an online account at this time, please continue shopping by clicking here.
fill out the form below to request a username and password for our online store. This login information will allow you
to purchase our products at the wholesale price.
After you have submitted the form, please fax a copy of your
license or degree to (425) 868-5393, attn: Customer Service. Once this is done, we will email you a username and password
for our online store so that you can login and purchase our products at the wholesale price.
Thank you for choosing to register
with Levine Health Products, Inc.