Apply to Become a Novacell Provider

Thank you for your interest in partnering with Novacell.
We work exclusively with licensed healthcare professionals committed to evidence-based, ethical regenerative care.

Please complete the form below to begin your provider application.
Once reviewed, our clinical team will reach out with next steps and access to the Novacell formulary and educational resources.

Provider Information

Full Name

Practice Name

Professional Title / License Type (ie DO, MD, NP etc. . )

If you are not licensed to prescribe we welcome you to apply for a referral account. Please tell us what type of practitioner you are (i.e. Health Coach, FDN etc. . .)

License Number

Licensing State / Country

Years in Practice

Practice Details

Practice Website

Practice Address

City / State / Zip

Email Address

Phone Number

How many patients do you currently serve per month?

Clinical Focus

Which areas best describe your patient population?

Regenerative Medicine Functional / Integrative Medicine Anti-Aging / Longevity Sports Medicine Aesthetics Chronic Illness / Complex Cases Neurology / Brain Health Womens Health/Hormones Mens Health/Hormones Endocrinology / Hormone Support Other (please specify)

Which products are you interested in?

Peptides Exosomes Both

Intent + Alignment

Why are you interested in becoming a Novacell Provider?

How do you currently source your peptides or exosomes?

What’s most important to you in choosing a peptide or exosome partner?

Pharmaceutical purity. Clinical integrity. Nervous-system intelligence.