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Complete the following section to apply for a Principal Lab account. Account holders receive access to the test menu, discount pricing, software demo, and download areas of the website. Principal Lab accounts require the appropriate scope of practice and licensure in the state where the account is established. Account application review can take up to three business days. You will be notified by e-mail of your account status.

We are not accepting account applications from the following states: NY, NJ, RI

* Indicates a required field.

First Name:	*	NPI:	*
	The first name is required.		The NPI is required. 10 digits.
Last Name:	*	License Type:	- Select One - Medical Doctor Chiropractic Doctor Osteopathic Doctor Acupuncturist Doctor of Naturopathic Medicine Naturopathic Doctor Naturopathic Physician Naturopath Naprapath Other *
	The last name is required.
Business Name:	*	State Licensed :	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NM NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS FM GU MH MP PW PR UM VI AA AP AE *
	The business name is required.
Telephone:	*	License Number:	*
	The telephone number is required. Telephone Number Is Invalid.		The license number is required.
Fax:		E-mail:	*
	Fax Number Is Invalid.		The email address is required. E-mail Is Invalid.
Street Address:	*	Confirm E-mail:	*
	The address is required.		The email address is required. E-mail Is Invalid. E-mails don't match!
Unit:		Create Password:	*
			The password is required.
City:	*	Confirm Password:	*
	The city is required.		The password is required. Passwords don't match!
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NM NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS FM GU MH MP PW PR UM VI AA AP AE *
Zip:	*
	The zip code is required. ZIP Code is Invalid.
Type the code from the image:	Generate New Image

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Dear valued health care practitioner,

Thank you for submitting your request for an account. Our automated system will verify your eligibility. We will reply to the email address you provided within 24 hours.

In good health,
Principal Lab.