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
    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 Provista Form Below

    Provista Form