ACA Chiropractors - Intake Form

Saatva Partner Activation

Complete this form to activate your account and optionally order free marketing materials for your practice. Doctors are advised to check with their state licensing board for any restriction or limitation that may apply to this or any other referral program.
Would you like no-cost in-office marketing materials for your office?*

YesNo
Email 2*
Please use the same email address that you received the link from
Name*

PrefixFirst NameLast Name
Email*
Enter your email address that you got this form from
1. How many retractable banners would you like? *
These retractable banners are 81" x 33". On average, partners who have one in their office are 3x more likely to make a referral and generate an additional $1000 in commission per month
Would you like a retractable banner? *
These retractable banners are 81" x 33". On average, partners who have one in their office are 3x more likely to make a referral and generate an additional $1000 in commission per month
Would you like to add your logo to the banner? *
Logo Upload*

Upload LaterUpload Now
Please Note

Please email your logo to b2b@saatvamattress.com within 24 hours to ensure we can fulfill this request. Logos can be PDF, PNG, or Vector format, with a file size greater than 200kb.
Logo Upload
Upload Your Logo (Supported Formats: PNG, AI, or Vector)*

Alternate Option: If you wish to have your logo displayed on the banner, please email us at b2b@saatvamattress.com and send a large PNG or Vector file. Files sizes must be 200kb or greater.
Cancelof
How many Restorative Mattress posters?
18" x 24" Mountable hard foam posters
How many Sleep and the Nervous System posters?
18" x 24" Mountable hard foam posters
1. How many Restorative Mattress posters?*
18" x 24" Mountable hard foam posters
1. How many Sleep and the Nervous System posters?*
18" x 24" Mountable hard foam posters
How many bundles of Double Sided Flyers?
8.5" x 11" flyers - 25 flyers to a bundle.
1. How many bundles of Double Sided Flyers?*
8.5" x 11" - 25 flyers to a bundle
How many Rx Pads?
Each Rx Pad comes with 50 sheets. Can be used for patient tax reimbursements upon valid prescription submission.
1. How many Rx Pads?
Each Rx Pad comes with 50 sheets. Can be used for patient tax reimbursements upon valid prescription submission.
Would you like a Booklet for your waiting room?*
Saddle stitched on premium glossy paper. 16 pages in total per booklet. Showcases all of Saatva's main products with company information.
1. Would you like a Booklet for your waiting room?
Saddle stitched on premium glossy paper. 16 pages in total per booklet. Showcases all of Saatva's main products with company information.

Phone Number*
Please enter a valid phone number.
Business Name*
Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
What would you like your discount/reference code to be?
ex. drjohn50 or chirosave50
As a part of Saatva's affilaite program, it is required that upon receiving in-office materials that you show 'proof of use' for the materials selected.

Upon reception of materials, please send a picture of the materials in use as displayed in office no later than 30 days after receiving materials. You can send pictures to the email address: b2b@saatvamattress.com or text them to 619.753.2745

If more than 30 days passes and the usage of your in-office materials isn't confirmed, we kindly ask that you ship them back to us for future use.

If more than 30 days is nessesary, please notify a Saatva employee or your program manager and let them know that more time will be needed. You can reach us at: chiro@saatvamattress.com

Please sign below for acknowlegement
Signature

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Click submit, then proceed to the link on the next page to finish onboarding and order your materials!

Welcome to Saatva!
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Saatva Partner Activation

Please Note

Logo Upload

Click submit, then proceed to the link on the next page to finish onboarding and order your materials!