Registration for U.S. Practitioners

Pre-Requisites forApplicants

Certain Products available from Avicenna LLC companies (dermatology-m.com & mazin-al-khafaji.com) only sell to practitioners and students of Traditional Chinese Medicine (TCM), Oriental Medicine and other licensed health professionals, or to patients with prescriptions from registered practitioners.

In order to access the practitioner section of the store, please register to apply for your personal login code. Once we have reviewed your professional status, you will be able to access to the professional section of the shop which includes the full range of our products, including special offers and wholesale offers.

For more information on eligibility, please see our customer statement.

If you are based outside of the United States of America or Canada, please contact us at info@avicenna.co.uk or register at Avicenna.

Non-Practitioner
Enquiries

Some of our products are available to you without supervision of a qualified practitioner. These can be purchased from the public storefront.

Should you like to make an appointment at the Skin Clinic with Dr. Al-Khafaji, please contact info@avicenna.co.uk

All other enquiries, please contact care@dermatology-m.com.

Personal Details
Salutation*
Name*
First Name Surname
Suffix
Email Address*
Country*
Apt #, Floor, Building, Etc.
Street Address*
City*
State*
State*
Zip Code*
Education
Specialties*
School*
State Association*
State Association*
National Association*
Practice
Clinic Name*
Practice Type*
Credential*
Credential*
License Number*
State*
State*
Expiration Date*
Month
Day
Year
State License Document (10MB Max)
Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 10 MB.
Phone*
Website
Account Security
Note: Password must be 8 characters or more*
Enter Password Confirm Password

Strength indicator

Note: Password must be 8 characters or more
Customer Statement
Avicenna LLC companies (dermatology-m.com & mazin-al-khafaji.com) only sell to practitioners and students of Traditional Chinese Medicine (TCM) and other registered health professionals, and to patients with prescriptions from registered practitioners.
- Dermatology-M sells to state-licensed and fully indemnity insured health practitioners of TCM.
- For states (in the U.S.A.) without licensure: health practitioners must be certified by The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM, at www.nccaom.org) as a Diplomate in Chinese Herbology or Diplomate in Oriental Medicine.
- Other licensed health practitioners (such as M.D.'s) may be eligible. If TCM and Herbal Medicine is in your scope of practice, please contact us for more information.
- Students must be enrolled in a school accredited by The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM, at www.acaom.org).
- Dermatology-M does not sell directly to the public at this moment. Patients must obtain a prescription from a registered practitioner to purchase products.
- If you are based outside the United States of America, please contact us at info@avicenna.co.uk.
Submission
- Your application can take up to a week to process
- You will be notified by email whether you have been successful
- A shopping account will be automatically created
Name
This field is for validation purposes and should be left unchanged.

Register for Practitioner Account

Pre-Requisites forApplicants

Non-PractitionerEnquiries

Personal Details

Education

Practice

Account Security

Customer Statement

Submission

SELECTYOUR SHOP

Non-Practitioner
Enquiries

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YOUR SHOP