Medical Professional Application

Join Efficacy Labs

Apply for membership to access premium peptides with volume pricing.

Membership Application

Complete the form below to apply for professional membership

First Name *

Last Name *

Email Address *

Phone Number *

License Number *

License State *

Upload License Copy

Click to upload or drag and drop

PDF, JPG, PNG up to 10MB

Practice Type *

Years in Practice *

Practice Name *

Practice Address *

City *

State *

ZIP Code *

Expected Monthly Volume *

Current Supplier (Optional)

I agree to the Terms of Service, Privacy Policy, and Research Disclaimer. I certify that I am a medical professional and the info provided is accurate.

Membership Benefits

• 24hr application review

• No membership fees

• Immediate access

• License required

Our team is here to assist with your application

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