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. 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.
First & Last Name *
Email *
Phone number *
Company or practice name. Based in a particular city or live online? Type of practice if not clear. *
You will have to market. Where will you be promoting HelpHeadPain.com? Patients / clients? 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 HelpHeadPain.com class? *
Is this user name and email associated with a Help Head Pain login already?
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