TruBalance Healthcare MD Application

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Personal Information

First Name: * Last Name: *
Address: City:
Province: Postal Code:

Daytime Telephone: * Cell Phone:

Email: *


Professional Information

Licence Number * Specialty:
Clinic Name:
How many clinics do you have?
Locations -


Are you currently practicing BHRT or TRT therapies?:
If Yes, for how many years?

Are you currently practicing the HCG Weightloss program?
If Yes, for how many years?


Are you interested in taking part in our BHRT Certification CME education?

The MD Partnership Program
You would have a team of naturopaths, registered nurses or nurse practitioners to work alongside. In this situation, they will order the lab tests, collect the medical histories, and do the full patient assessments. The MD would see the patient for a consultation, review history and relevant information, then issue the Rx.
Are you interested in working within a clinic as a BHRT MD?

If there is any additional information that will be important in our reccomendation, please tell us a little about it here:



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