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


Help
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.
Fields marked with * are required.
First Name *
Last Name *
User ID *
Your User ID must be at least 5 characters in length and will be required each time you log into the site. Please select a name that you can remember. Please keep this information in a secure location for future reference.
Password *
Your Password must be at least 6 characters in length and will be required each time you log into the site. This password should be a combination of letters and numbers that only has significance to you. Password must have at least one numeric value.
Phone *
Fax
Email *
Password Question *
If you forget your password, the question you have entered above will be used to verify your identity.
Password Answer *
Primary Account *
Additional Account Numbers
(one per line)