Health Professional Registration Form

We invite health professionals, e.g., doctors, psychologists, coaches, etc. who work with clients and patients in a practice, to open an account with HeartMath LLC and obtain products at a discount. Please fill out and submit the form below, and we'll provide you with access to the health professional discount order form on the Web site. We will also send information to help you use our products and techniques in your practice.

(Items in red are required.)

First Name
Last Name
Suffix
Organization
Address

City
State
Postal Code
Country
E-Mail
Phone
Web site
Do youOwn an emWave® PC Stress Relief System (formerly Freeze-Framer®) or emWave® Personal Stress Reliever®?
If so, do you use any of these HeartMath technologies in your practice?
How did you hear about HeartMath?
Please describe your practice (credentials, patient/client population, conditions treated)


Please give us your comments

Carol Thompson
Director of Health Professional Programs
Telephone: (800) 450-9111, Ext. 781 (Toll-Free)
Telephone: (831) 338-8700, Ext. 781 (International)
E-Mail: carol@heartmath.com

Tom Beckman
Assistant Director Health Professionals Program
Telephone: (800) 450-9111, Ext. 745 (Toll-Free)
Telephone: (831) 338-8700, Ext. 745 (International)
E-Mail: tom@heartmath.com