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Registration

As a health professional, you may place wholesale orders by phone, by email, by fax, or here on the site. While you are not required to complete our online registration in order to begin placing orders, we strongly encourage you to register. By registering, your clinic information will be included in our online directory for consumers.

Once you complete your online registration, an Original Quinton administrator will approve your registration. You will then receive an email that confirms that you have been approved and that you may now begin ordering online.

For your convenience, once you complete your online registration you may call our office at (888) 278-4686 to request that your application be approved immediately.

NOTE: In our online directory, your contact information will appear exactly as you enter it below!

Fill out the Registration Form below, hit submit, and fax or mail us a copy of proof of your degree, certification or license to practice to (714) 522 7195. Please include a cover page with your name and the username and email that you used for registration.

Original Quinton
ATTN: Health Prof. Registration

Corporate Mailing Address:
Original Quinton
6900 Aragon Circle, Buena Park, Ca 90620

Toll Free: (M-F 9AM-4PM PST) Fax: 714-522-7195

Email: info@originalquinton.com
First Name: * -
Last Name: * -
Username: i * +
E-mail: i * +
Verify Email:
Password: i * -
Verify Password: * -
Company: * +
Address: * +
Suite/Unit: +
City: * +
State: * +
Zip Code: * +
Phone: * +
Fax: +
Include in referral directory for patient referrals: Yes No i +
Office Representative Name: +
website: i +
Occupation: * +
Country: +
Reseller#: i +
Do you charge sales tax?: * +
Do you accept back orders?: * +
Degree(s)/ Certification(s), License(s).: i * +
Specialty / Modality (Hold down CTRL key to select multiple modalities): i * +
  Accept Terms and Conditions
 
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