Create An Account  //  Fill out the form below to request access to the full site.

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Create A Website Account

In order to access our site you will need to complete the form below to request a website account. Once you have an account, you will be able to view our products, prices and more.

We require user accounts to access this information so we can ensure that only knowledgeable professionals use our website and have access to our proprietary products and information.


Instructions

All of the fields marked with an asterisk are required. Once you submit the form, one of our employees will verify the information provided and then activate your account if you qualify. Once your account is approved by us, you will receive an email letting you know that you can log into the web site. Please make sure that you provide a valid email address so that you receive the notification! You will have to check this email address to finish creating your account.

Your Information
Title*   
First Name*    First name is required.
Middle Initial   
Last Name*    Last name is required.
Business Name*    Business name is required.
Address*    Address is required.
Address 2   
City*    City is required.
State*    Please select a state.
Postal Code*    Zip code is required.Invalid format.
Country*    Please select a country.
Phone Number*    Phone number is required.Use the format (800) 555-5555.
Email Address*    Email is required.Invalid format.
   

Electro Dermal Screening
Do you currently own any Electro-dermal Screening (EDS) system?   Yes No
If so, what is the manufacturer of the system?  
Have you been tested on an Electro-dermal Screening (EDS) system?   Yes No
If you have been tested, who performed the test?  
     
If you own a Discovery System from Consolidated Wellness Solutions, LLC, what is the hardware serial number of your device?
(This is found on a sticker on the bottom of the Discovery unit)		  
     
If you own a Discovery System from Consolidated Wellness Solutions, LLC, what is the serial number of your device?
(This is the serial number you can find using the Discovery Software. Within the software, go to the "Help" menu and choose the option shown as "Get Discovery License" and input the 4 digit code here.) 		  Enter a number.
 

Preferred Contact Method
How do you prefer to be contacted?   Email Postal Mail
Note: we will never sell, lease, or share your information with anybody.
 

Web Site Usage
Are you interested in our products for personal or professional use?   Please select an item.

(Reminder - We do not allow public access to our web site. If you request access to the site we will have to verify your professional credentials before granting your access to the site.)
     

Password
Password*   Password is required.
     
You may choose your own password but your Username will be your Email address.
 
Remember, once you submit this form one of our employees will then verify the information. Make sure your email address is correct and that you will be able to receive mail at the address - you will not be able to activate your account otherwise.
   
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