LoMed Pain Management | Safe Narcotics for Pain | Philadelphia Pain Specialists
A Safe Narcotic Option for Pain Management.

Provider Registration

Provider Listing Registration

 
 
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Please fill out the following form in order to submit your practice on our LoMed provider page.

 
Physician
Physician
Checkbox *
Clinic Number
Clinic Number
Address
Address
http://
Would you like your email address posted on our listing site? *
Additional Clinics
Additional Clinics
Email Agreement *
I Agree to receive emails from Baxter, T. Inc
Provider Agreement *
I opt to participate in the Baxter, T. Inc. listing provider website page and have provided my contact information. I understand that this is not an endorsement or recommendation by Baxter, T. Inc. Inc. and I agree not to make any such claims or representations. I agree that Baxter, T. Inc. is not responsible for my treatment outcomes.
E-sign *
E-sign
Please sign your name.
Date *
Date
Contact agreement *
I consent for my contact information to be posted on LoMedPain.com and to be provided by Baxter, T. Inc. representatives.