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

  • Contact Name*
  • DPM Name (if different from above)
  • Business Name
  • Email*
  • Phone Number*
  • Fax Number
  • Preferred Contact Method EmailPhone
  •   We have multiple locations.
    Business Address

  • Street Address
  • City
  • State
  • Zip Code
  • Shipping & billing address the same?   YesNo

    Shipping Address Optional

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

    Continue to Intalere Form Below.

    Intalere Form