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New Providers: Setup Form

If you would like to become a NIFTY Test Provider, please fill in the below form. We will review the form and one of our local sales representatives will then contact you with information specific to your country of residence. After this, we will then be able to create you an account for access to the provider section of the website and send you the test kits so you can start offering Nifty.

Thank you for filling in the form. We will endeavour to respond to you within 48 hours, Monday-Friday.
STEP 1 Account Information
STEP 2 Shipping Information
STEP 3 Physician/Test Provider Information
STEP 4 Billing Information
Please check if kits should be shipped to the main business address previously provided, for the attention of main contact.

 yes
Check if the results should be sent to the attention of Main Contact

Test results should be delivered to:

Billing address is same as main account address.

I agree with terms and conditions.

Please agree with terms and conditions