Physician Verification

In order to validate qualified physicians interested in serving their patients using InfantEar™, we request your information before being able to purchase. The physician-only area also has in-depth information on how the procedure works and what you can expect.  Please fill out this form and we will email you a password within 2 hours.  To place an order immediately, contact us at (888) EAR-2221.

Name *
Name
Office Address *
Office Address