Setup Your Account

To open an account, simply fill out the form below, and we will respond within 2 business days to confirm your application.

You will also receive information on billing, shipping, and consultations with Dr. Khangura. If you would like to speak to us directly before opening an account, please feel free to Contact Us.

Please complete the form below

Physician Name *

Physician Name

First Name

Last Name

Professional Designation *

If Other, Please Specify

License Number

Other Health Care Providers

Please list the other health care providers within the office that may use SIBO Diagnostics. This allows for each health care provider to receive confidential results reporting.

Clinic Name

Clinic Address *

Clinic Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Phone

(###)

###

####

Email Address *

Clinic Contact

Person of contact at clinic, if not ordering physician. (i.e. Office Manager/Administrator)

Message

To place your credit card on file, please download and send us the Credit Card Payment form below via email or fax (778-265-8341) in order to expedite your account setup.

Credit Card Payment Form

To Order SIBO Testing Kits, please ensure your account has been setup and your payment information is on file. Kits can be ordered by clicking here.

For FREE SHIPPING, the following MINIMUM orders apply:

3 KITS for Western Canada, including British Columbia, Alberta, Saskatchewan and Manitoba
6 KITS for Eastern Canada, including Ontario, Quebec, the Maritime provinces.

To place your credit card on file, please download and send us the Credit Card Payment form below via email or fax (778-265-8341) in order to expedite your account setup.

Credit Card Payment Form