Join Talar

Join Talar
Member Portal

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 EmailPhone
  •   We have multiple locations.
    Address
    Business Address

  • Street Address
  • City
  • State
  • Zip Code

    • Shipping & billing address the same?   YesNo

    Shipping Address Optional

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

    Continue to Intalere Form Below.

    Intalere Form