Provider Form

Terms and Conditions

• The information provided within this form is accurate.
• I have been trained by LMT on the proper use of the products selected
• I have read the associated instruction manuals for the products selected
• I acknowledge that LMT reserves the right to remove my information
• I acknowledge that I can request my details are removed at anytime
• I acknowledge this listing is not an endorsement of any particular provider
• I acknowledge that the patient maintains the responsibility of selecting a provider
• As LMT only lists information, your (my) acceptance of these terms will release and indemnify LMT from any liability with regards to any patient who contact you (me) through this listing.
• I acknowledge LMT’s provision of this service is not to improperly influence purchase of products decisions.
• LMT will review physician enrollment and case volume every 18 months. Failure to achieve the minimum product utilization will result in removal
• I have read and accept all the terms and conditions stated above