Become a Provider

Become a CarpeVITA Genomics ProviderBecome a CarpeVITA Authorized Provider and you’ll be able to provide enhanced services that will lead to better prediction, prevention, personalization and participation for your members/clients. Our genomic tests allow you to work together with your members/clients to determine their genetic strengths and weaknesses related to health, as well as the lifestyle adjustments that will work best for them. This allows you and your member/client to collaborate in a more effective way to ensure their best health and wellness.

To sign up to be a CarpeVITA Authorized Provider, please complete the following steps:

1)  Read the CarpeVITA Authorized Provider Agreement (Or you can download and fax in the agreement here: CarpeVITA Authorized Provider Agreement PDF).

2)  Complete the form below (Or you can download and fax in the application here: CarpeVITA Authorized Provider Application PDF.

Provider Application

You may contact us by filling in this form any time you need professional support or have any questions. You can also fill in the form to leave your comments or feedback.
Name:*
Company:
E-mail:*
Phone:
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Address:*
Tax ID #:*
Provider Type:
Website:
Shipping Address (if different than Primary Address):
Have you read and agreed to the terms set on the CarpeVITA Healthcare Provider Agreement? (If not, please visit this page before proceeding: https://carpevitaprecisionhealth.com/carpevita-healthcare-provider-agreement/)*
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