Sign Up - 1300 Foot Lab

Clinic Details

Responsible for paying accounts

First Name *

Last Name *

Email Address *

Confirm Email Address *

Mobile

Business Name *

Legal Entity Name *

ABN/ACN Number *

Landline Number

Clinic Address *

Address Line 1 *

City *

Region *

Postal Code *

Country *

Deliver to the same address?

Yes

Delivery Address

Address Line 1 *

City *

Region *

Postal Code *

Country *

Prescribers Names

Prescribers *

Add Remove

Billing Details *

Same as Clinic Details

Different Account Details

Billing Details

Your Company Legal Name, ABN. Clinic Address will be used for your Billing.

Contact Number

Email

Account Contact

Invoice Sent

I agree to the Terms and Conditions *

Yes

Back to Admin Dashboard

Back to Podiatrist Dashboard

Clinic Details

Prescribers Names

Billing Details

Back to Admin Dashboard

Back to Podiatrist Dashboard

Clinic Details

Prescribers Names

Billing Details

Login