Join Talar

Join Talar Medical

Fill out the following form.  Once submitted, click on the Intalere button located the bottom of this page to complete the Intalere registration. 

Member Information

  1. Contact Name*
  2. Email*
  3. DPM Name (if different from above)
  4. Business Name*
  5. Phone Number*
  6. Fax Number

Shipping Information

Business Address

  • Address*
  • City*
  • State*
  • Zip Code*
  • Shipping Address same as above?* YesNo
  • Preferred Contact Method EmailPhone
  •   We have multiple locations.
  • Shipping Address Optional

  • Address
  • City
  • State
  • Zip Code
    1. Optional
    2. Number of providers in your practice:
    3. Is this a generalized number? YesNo

    Continue to Intalere Form Below.

    Intalere Form