Provider Finder

The information provided by you will allow us to accurately list your facility on the VitalStim Therapy® website. The listing of your facility will indicate to patients and referral sources that it is a site where active VitalStim Therapy® is taking place.

For liability and patient safety reasons, we can only list facilities where VitalStim brand equipment and electrodes are used (please refer to the Provider Finder Policy). In order to assure the accuracy of the Provider Finder, facilities will be contacted annually via email to update their information.

Required*

Facility Name:*

Street:*

City:*

State:*

Zip Code:*

Contact phone number to schedule an appointment:*

VitlStim certification number:*

I certify that VitalStim brand equipment is being used to treat patients at this facility.

Yes
No

VitalStim device serial number:

I Certify that VitalStim brand electrodes are being used to treat patients at this facility.

Yes
No

The following patients are treated with VitalStim Therapy® at this facility: Adults
Pediatrics
Both

Experia device is used at this facility:

Yes
No

Person to be contacted for updates to this facility listing: Email address: * Confirm Email: *

Provider Finder Policy