For Patients with Active Registry Numbers ONLY. If you receive the message "This account already exists in our database", then you do not need to register. Simply log in with your Patient Card Number as your "Username" (exactly is it is on your patient card) and your last name as your "Password". You can make changes to your account once you log in with these credentials. If you have any issues with this, please call us at 269-459-1477.
First Name *
Last Name *
Email Address *
Password *
Phone *
Birth Date *
Driver's License Number *
Driver's License Exp. Date *
Address *
City *
State *
Zip Code *
How did you hear about us? *
How would you like to be contacted? *
Recommendation Number *
Recommendation Exp. Date *
Before you will be able to pick up a pre-order, your ID and Patient Registry Card will be required at check-in. Anyone without these items will not be able to make a purchase.