MHC Registration Form

MHC (Medoptimal Healthcare Consultancy) Client Application


No credit card information is needed on this form.

For your privacy and security, we do not require credit card information on this form. Instead, you'll be prompted to enter your credit card details directly during the secure checkout process, powered by Stripe.


Business Information

Please provide your business information below.


This will also be your login username for your online account on www.medoptimal.ca

Contact Information

Please provide the primary contact information below.


Additional Shipping Addresses and Staff Accounts

Once your online account is set up, you'll be able to add additional shipping addresses and staff accounts directly within the 'My Account' section for streamlined management.

 

Shipping Information

Please provide the primary shipping location here.


At this time, we only provide products and services to clients in Ontario. We will keep you updated when we are ready to expand.

Additional Shipping Addresses and Staff Accounts

Once your online account is set up, you'll be able to add additional shipping addresses and staff accounts directly within the 'My Account' section for streamlined management.

 

Authorization Information


Shop
My account
Your Cart

No products in the cart.