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SALES REPS FORM

Please enter the information for the client that you wish to register. Once submitted you will receive an email back confirming that the client is registered and assigned to your account. Client must be approved by My Safe Pass in order to be registered.

Representative Info

Client Info

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Seek medical attention if the test detects a loss of olfactory function. The absence of an abnormal test does not rule out that you have a disease or other conditions. Consult a healthcare professional, if you have symptoms of concern. The results do not consist of medical diagnosis and are not in place of a medical test of any kind.

TM

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