Providers - Jinfiniti Precision Medicine

Contact Name*

First Last

Clinic or Company Name*

Your contact phone number

What email do you want your patient/client results to be connected to?*

Shipping Address

Street Address Address Line 2 City State ZIP Code

Billing address different from Shipping Adress?

Billing Address

Street Address Address Line 2 City State ZIP Code

Preferred Method of Payment

Credit Card

Stipe Payment Link

ACH

Cardholder's Name

Card Number

Card Expiry Date

CVV/CVS

Email To

Email ACH Form To

Request Training Session with Dr. She

Yes

No

Dr. She is the leading expert in NAD and you will have direct access to him via a training session and on an ongoing basis.

Preferred Days*

Preferred Time (Eastern Standard Time)*

24 Hour Format

Marketing Needs

None

Brochures

In Clinic Posters

Digital Materials

Others

What Would You Need ?

Join the rapidly growing community of Providers partnering with Jinfiniti