Elektra Health Provider Information
Thank you for reaching out! We are thrilled to support you and your patients. Please complete Section 1 of the form below and a member of our team will connect to get Elektra patient-facing materials in the mail to you ASAP.

Interested in going deeper with Elektra? Menopause care is a team sport, and we are always looking for other exceptional providers with which to collaborate. When you apply and are accepted for our Referral program, you'll be featured in our Preferred Provider Network. Additionally, you can be considered for other opportunities to work together through professional collaborations and internal opportunities.

If you'd like to be considered for our Referral program, please make sure to also complete Section 2 of the form. We will be in touch soon!

- Alessandra & Jannine, Elektra Co-founders
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First name *
Last name *
Credentials *
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Your specialty *
Email address where we can send you Elektra information. *
Practice name *
Practice mailing address *
Practice phone number *
Mailing address where we can send patient-facing Elektra materials (leave blank if same as your practice address)
Would you like explore Elektra's Meno-morphosis platform for yourself, for free? If yes, we'll send you a link to sign up for our basic membership along with a discount code.
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How did you learn about Elektra? *
What is something you wish you had in practice (that you don't currently) to better support your menopausal patients?
Anything else we should know?
Would you like to become part of Elektra's Preferred Provider Referral Network? *
Thank you!
Continue to the next section for more information about Elektra's Preferred Provider Network
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