Clinic Application
Apply to join SlimTherapy’s Network of Partner Clinics and start offering our treatments to your patients.
Clinic Information
Please provide the following so we can contact you regarding your application.
Clinic name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact
This is the person we’ll contact regarding your application and partnership with SlimTherapy.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Payment Information (for commission payouts)
Please provide your bank details or Zelle phone number for commission payments. All fields are required.
Preferred Payment Method
*
Zelle
Bank Account
Zelle Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zelle Email
*
example@example.com
Account Type
*
Checking
Savings
Bank Name
*
Account Number
*
Read the full Affiliate Program
Terms & Conditions
.
Submit Application
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