Affiliate Application
As an Affiliate you will get your own set of unique links that you can use to send traffic to Help Head Pain.

If it is their first visit to Help Head Pain and they arrive via your affiliate link, it will be tracked with cookies. If they go on to make a purchase you will receive your commission of 30% (after coupons or discounts). This will happen even if the visitor doesn’t enroll at first. If they come back and enroll within 30 days, it will be credited to you as the Affiliate.

Sign in to Google to save your progress. Learn more
First & Last Name *
Profession *
Email *
Phone number *
Company or practice name. Based in a particular city or live online? Type of practice if not clear. *
Website of company / practice *
You will have to market. Where will you be promoting Patients / clients? Clickable link on your website? Blog posts? Please list URL's of websites, social media channels, etc. *
Payments are made monthly via Paypal. Please enter your Paypal email here: *
Have you or a staff member gone through a class? *
Is this user name and email associated with a Help Head Pain login already?
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy