1 Create your profile Provide your contact information and set up your account login.

2 Complete the program’s authorizations and releases Review and complete necessary authorizations, consent and releases.

3 AWAIT YOUR ACCOUNT ACTIVATION We will send you an email to activate your account. This email will have your account information, as well as links to your important files and resources.

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Profile Information

All fields are required unless specified

Email Address (This will also be your username)

Phone Number (Omit spaces and parentheses)

Enter Password (Must be at least 6 characters)

Confirm Password

First Name

Last Name

Professional Information

Name of Practice or Clinic

Work Street Address

Unit, Apt, Suite, Bldg

City

State

Zip Code

Select from the following options:

I’m establishing an account for a healthcare clinic or system with multiple Healtcare Providers

I’m establishing an account as a sole practitioner

Organizational NPI (Type 2)

Optional: Individual NPI (Type 1)

Choose a Designation

Legal authority

I do not have the legal authority to bind the healthcare clinic or system

I have the legal authority to bind the healthcare clinic or system

Please provide the information of the individual in your organization who has legally authority:

First Name

Last Name

Title

Email Address

Consent and Releases

I declare that I am a licensed Healthcare Provider in the United States, Puerto Rico, Guam, or the U.S. Virgin Islands and I want to register for the VIVUS Health Platform. This declaration authorizes VIVUS to contact me and confirm and validate the professional information provided during the registration process.

I understand that by completing this registration, I am authorizing VIVUS or its designee to contact me by telephone, direct mail or email. For more information about VIVUS’ privacy practices please view the Privacy Policy.

Terms of Use

1 REVIEW THE DOCUMENT

Open and review the Terms of Use

2 PROVIDE ADDITIONAL INFORMATION

I have reviewed and AGREE to the Terms of Use

3 ELECTRONICALLY SIGN & SUBMIT

Electronic Signature:

BAA (Business Associate Agreement)

1 REVIEW THE DOCUMENT

Open and review the BAA (Business Associate Agreement)