Physicians & Nurses Signup Form

Please use the form below to set up your account at TealHeal. Once this form is submitted, our team will contact you to assist you with next steps.

A valid email address. All emails from the system will be sent to this address. The email address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by email.
Several special characters are allowed, including space, period (.), hyphen (-), apostrophe ('), underscore (_), and the @ sign.
Provide a password for the new account in both fields.

Date of Birth

Please provide the address where you'd like your test kits shipped