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 / Province / Region ZIP / Postal Code Country

Billing Address

Same as Shipping Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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 ?

Where did you first learn about Jinfiniti?*

Join the rapidly growing community of Providers partnering with Jinfiniti