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If you have questions, email us at **[hcpinfo@pendulumlife.com](mailto:hcpinfo@pendulumlife.com).** NPI number \* * * * First name\* Last name\* Email\* Phone\* Afghanistan +93Albania +355Algeria +213American Samoa +1684Andorra +376Angola +244Anguilla +1264Antarctica +0Antigua And Barbuda +1268Argentina +54Armenia +374Aruba +297Australia +61Austria +43Azerbaijan +994The Bahamas +1242Bahrain +973Bangladesh +880Barbados +1246Belarus +375Belgium +32Belize +501Benin +229Bermuda +1441Bhutan +975Bolivia +591Bosnia and Herzegovina +387Botswana +267Bouvet Island +0Brazil +55British Indian Ocean Territory +246Brunei +673Bulgaria +359Burkina Faso +226Burundi +257Cambodia +855Cameroon +237Canada +1Cape Verde +238Cayman Islands +1345Central African Republic +236Chad +235Chile +56China +86Christmas Island +61Cocos (Keeling) Islands +672Colombia +57Comoros +269Republic Of The Congo +242Democratic Republic Of The Congo +242Cook Islands +682Costa Rica +506Cote D'Ivoire (Ivory Coast) +225Croatia 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Fitness Professional Health Coach Health Food Store Medical Doctor Midwife Naturopathic Doctor Nurse Nurse Practitioner Optomoetrist Osteopathic Doctor Pharmacist Physician Assistant Physical Therapist Veterinarian Other healthcare profession\* * * * Name of Business\* Address Line 1\* Address Line 2 City\* State\* Zip Code\* * * * Business website\* How many patients/clients does your practice see per week?\* How many locations does your practice have?\* How many providers are in your practice?\* How do you typically see patients?\*How do you typically see patients?\* In-person Virtual Both in-person and virtual What is your primary area of specialty?\*What is your primary area of specialty?\* Aesthetic Medicine Bariatric Surgery Cardiology Dermatology Endocrinology Family/Internal Medicine Functional Medicine Gastroenterology General Surgery Hematology Infectious Disease Integrative Medicine Nephrology Neurology Neurosurgery Obesity Medicine OBGYN/Women’s Health Oncology Orthopedic 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If your healthcare business is tax exempt, please email your reseller certificate to **[hcpinfo@pendulumlife.com](mailto:hcpinfo@pendulumlife.com).** * * * How did you hear about us?\*How did you hear about us?\* Conference Webinar Podcast Colleague Patient Social media Newsletter Email Quicksilver Rep Other Other\* Which conference?\*Which conference?\* A4M Spring Congress A4M Longevity Fest IFM AIC IHS Other Other conference\* Which webinar?\*Which webinar?\* Pendulum Gut Health Summit DIFM WorldLink Medical Fullscript A4M Dr. Kara Fitzgerald Dr. Jill Carnahan Performance Nutrition Professionals IFNA Rupa Health Diagnostic Solutions Laboratory Learn Skin American Nutrition Association Obesity Medicine Association Dr. Talks AmSpa Andrew Weil Center for Integrative Medicine GastroANP Other Other webinar\* Which podcast?\*Which podcast?\* Peter Attia Andrew Huberman Kevin Rose Mark Hyman Kara Fitzgerald Jill Carnahan Mindy Pelz Steven Gundry Dave Asprey Forgiven Nutritionist Greg Jones Other Other podcast\* Which social media platform?\*Which social media platform?\* Facebook/Instagram LinkedIn TikTok Other Other platform\* What is the name of the colleague?\* Which Quicksilver Rep?\*Which Quicksilver Rep?\* Brock Young Sherleen Olson Jordan Santilli Tim Reardon Brady Nielander Brady Rude Letitia Garcia Kristin Klaus Emily Phillips Sam Swanson Deena Scott Erin Fisher Tim Stornetta Matthew Walters Tim Buist Mathew Malone Other Other representative\* Email sender\*Email sender\* Pendulum Therapeutics American Association of Nurse Practitioners (AANP) American Association of Naturopathic Professionals (AANP) American Chiropractic Association (ACA) American Diabetes Association (ADA) Diabetes Dietitian Practice Group (DDPG) Dietitians in Integrative and Functional Medicine (DIFM) Other Other sender\* * * * By clicking on Create Account, you agree to Pendulum's [Terms & Conditions](https://pendulumlife.com/pages/terms-and-conditions), [MAP Policy](https://pendulumlife.com/pages/map-policy), and [Authorized Reseller Policy](https://pendulumlife.com/pages/reseller-policy). 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