Schedule

E-MAIL

[email protected]

BILLING QUESTIONS

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Please fill out the following form if you are interested in FNT Immersion Training

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Name:

First

Last

Clinic Name (if currently in practice):

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Email:

Phone:

Age:

Chiropractic School of Graduation:

Year Graduated:

Years in Active Practice:

Primary Technique:

Please note any chiropractic organizations and/or associations that you participate with: (ex: WSCA, ACA, ICA, QAC, CCA, etc.)

Disclaimer and authorization

I understand that by submitting this application, I am requesting consideration for acceptance into the FNT Immersion Training program with Dr. Avery Martin. I understand that I will have a personal phone call with Dr. Martin to discuss the possibility of an FNT Immersion program done in my location, and that a minimum of 3 doctors and maximum of 6 doctors are required. I understand payment is due in full prior to Dr. Martin's visit, by all attending doctors. I understand that no filming, recording, or pictures are allowed during any of the Immersion workshops, zoom calls, and that I will not share any emails received from Dr. Avery Martin.

Please fill out the following form if you are interested in The Synapse

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Name:

First

Last

Clinic Name (if currently in practice):

Please note the month you would like to start:

Synapse Agreement

I understand The Synapse program includes weekly emails and 1-2 scheduled Zoom calls per month. The cost is $200/month and I can start and stop this program at any time. I understand that months are not prorated. Payment will be automatically billed via my credit card and that I must contact BHealthy directly to cancel my subscription.

Email:

Phone:

Billing Address:

Address Line 1

Address Line 2

City

State

Zip Code

Chiropractic School of Graduation:

Year Graduated:

Years in Active Practice:

Primary Technique:

Disclaimer and authorization

I understand that by submitting this application, I am requesting consideration for participation in The Synapse. I understand that upon acceptance, I must provide a valid billing credit card. I understand that this is a monthly commitment and I can cancel anytime, but there are no prorated discounts or refunds.

E-MAIL

[email protected]

BILLING QUESTIONS

[email protected]