Register to Become a Vital Tears Provider

Complete the form below to become a Vital Tears provider.
Each physician within the clinic will be assigned a username, which requires a unique email address.
Once submitted, a member of our Vital Tears team will personally follow up.

Clinic Information

Office Hours


Enter the name, license and contact information for each physician at this clinic location. Each physician must have a unique email address.

Add Physician


Enter the name and contact information of at least one coordinator, along with the name(s) of the physician(s) they serve (or "all" if appropriate). This could be an office administrative assistant, nurse or scribe. Please do not re-enter a physician's name as the coordinator.

Add Coordinator

This will allow support staff to log in and create orders on behalf of various physicians within the clinic.

Blood Collection