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

    Contact Name*
    DPM Name (if different from above)
    Business Name
    Email*
    Phone Number*
    Fax Number
    Preferred Contact Method
    Address
    Business Address


    Street Address
    City
    State
    Zip Code

    Shipping & billing address the same?

    Shipping Address


    Street Address
    City
    State
    Zip Code
      Optional
    1. Number of providers in your practice:
    2. Is this a generalized number?
    3. How did you hear about Talar Medical?
    4. Who referred you?

    Continue to Intalere Form Below.

    Intalere Form