The full name of the practitioner as it appears on your billing method.
List additional certified practitioners. Please email lee@magnawavepemf with additional practitioners if there are more than two (2) practitioners working at this company
Best number for people to contact for appointments
This is your general service area and must be an exact address in order to be included on the Map your address will not be on the map just a circle for service area UNLESS you choose to have your Business address listed in the Next question please select YES , If you have multiple Address please include that in the Notes section below, multiple locations are approved on a case by case basis.
Please Choose YES if you have a business and would like people to Visit your location, Please select NO if you just want your general area on the MAP
EX: 10 mile or 50 mile radius from you business address
If you do not have a website or you are purchasing one through us please choose from an option below.
If you already have a website leave this field blank. We work with a company called Jazzro who makes customized websites with multiple templates to choose from. Please select from one of the options above.
A link to your social media EX: Facebook page
Please select all the levels of Certification you have completed we will cross reference this with our own records to make sure all is up to date. Currently if you have passed equine you have passed small animal.
Please write a paragraph explaining who you are and who you treat, any other schooling or information you want people to know about you, your company and your qualifications - please add in any areas you travel too etc - YOU CAN ALSO UPLOAD A WORD DOCUMENT WITH THIS INFO BELOW
Accepted file types: jpg, jpeg, png.
Please upload your logo. If it is too large to upload here, please contact Marissa at firstname.lastname@example.org
Magna Wave works with designers to help businesses create customized logos. If you do not have a logo and are interested in learning how MW can help please select one of the options and contact us at email@example.com or call (502) 742-7868.
Accepted file types: jpg, png, gif, jpeg, pdf.
Please upload a clear close-up headshot of yourself only, please.