Join the AMERX Network Today

If you are a provider interested in dispensing AMERX Health Care's line of advanced wound and skin care products, please fill out the form below. If you are a current AMERX Health Care customer looking for assistance with online purchasing, please use the Contact Us form on our website or call your Account Manager at (800) 448-9599.

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Practice Contact Information

Practice/Facility Name *

Physician Name *

Office Manager or Secondary Contact *

Street Address *

Suite, Apt., etc.

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City *

State *

ZIP Code *

Phone *

Email *

Additional Practice Information

Do You Have Satellite Locations? *

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How Many Total Offices? *

Number of Physicians in Practice *

Number of Treatment Rooms *

How many diabetic patients do you see on a weekly basis? *

How many wound care patients do you treat on a weekly basis? *

How many matrixectomies (partial and total) do you perform on a weekly basis? *

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Join the AMERX Network Today

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Dispensing Product

Practice Contact Information

Additional Practice Information

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AMERX Health Care Corporation