ASD Healthcare
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Customer Service(800)746-6273

Monday - Thursday
7am - 6:30pm CST

Friday
7am - 6pm CST

24hr Emergency
On-call


New Account Registration

To place an order, you must have an account established with ASD Healthcare. To establish an account please download, print and complete the New Account Form. Fax or mail to us with a copy of your state license. We must have a signature on the application form and a physical copy of the license. Once you have established an account with ASD Healthcare, you may then sign up for a web account to begin ordering online.

New Account Form (Adobe PDF)


Existing ASD Healthcare Customers

If you currently have an established account with ASD Healthcare and would like to begin purchasing products online, please fill out the form below and click submit when complete.

Company Name  
Address  
City  
State  
Zip  
Phone - -
Email    
First Name  
Last Name  
Login ID    
Password  
Password should be between 6 - 10 characters - at least one of which is a numeric value.
Password can include one or all capitals.
Password cannot contain spaces or @ ( ) / \ : ; , “ < > * = | ? + [ ] !
Re-enter Password  
Password Question  
Password Answer  
Your Account Number(s)
More than one account number can be entered separated by commas (no spaces). Don't know your account number? Please call customer service at 1-800-746-6273.