Magna Wave PEMF Web Update

Magna Wave PEMF Practitioner Update Form

PEMF Practitioners Info Update Request

  • Update Information

    This form is to collect any info that you need to be changed on your profile page on Magna Wave's corporate site. If you have a business website then this info will be changed there as well. Only fill out sections that need to be updated, if info stays the same do not fill out that section.
  • The full name of the practitioner as it appears on your billing method.
  • 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.
  • EX: 10 mile or 50 mile radius from you business address
  • Did your website address change?
  • 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, small animal testing will be included in 2017 continuing education
  • Any updated text for your bio section.
  • Drop files here or
    Accepted file types: jpg, jpeg, png.
      New logo file?
    • Drop files here or
        Please upload a clear close-up headshot of yourself only, please.