Professional Registration

Becoming a ProKinetics® Insoles provider is quick and simple. All you need to do to place your first order is to register below. After registering, you'll get instant access to the full user manual.  We will return your initial account name and password by e-mail within 24 hours (weekdays) so you can have access to prices and professional discount information. 

First Name
Required.
Last Name
Required.
Middle Initial
Company Name
Street Address
Required.
Apt/Suite
Or use for second address line.
City
Required.
State/Province
Required.
Zip/Postal Code
Required.
Country
If not USA, type your country here.
Phone Number
Required. Please include country code if outside North America.
E-Mail
Required.
Specialty
Required. Specialty under which you are licensed to practice.(choose from list)
State License
Required. Location of primary practise. (choose from list)
Practice
Primary Focus
Required. Select the primary focus for your practise. (choose from list)
Secondary Focus
Required. Select the secondary focus for your practise. (choose from list)
How you discovered Posture Dynamics
Required. How did you learn about Posture Dynamics. (choose from list)
Search engine
If you found us on the web please tell us what search engine you use. (choose from list)
Action Request
Required. What do you want us to do? (choose from list)
Any other requests or comments you wish to leave (Optional)