Clinic Discount
This form is intended for five therapists taking at least 3 different courses each, but wanting to be placed under one purchase order. The clinic discount offers 25% discount. If there is a need to include more than 5 therapists, please complete the form again with the additional therapist. If you do not have 5 therapist in the clinic, please send an email prior to completing this form.
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Email *
Clinic Information *
Name, website, and full address
Therapist #1 *
Please include name, email, and license number
Which courses would you like to include for therapist #1? *
Required
Therapist #2 *
Please include name, email, and license number
Which courses would you like to include for therapist #2? *
Required
Therapist #3 *
Please include name, email, and license number
Which courses would you like to include for therapist #3? *
Required
Therapist #4 *
Please include name, email, and license number
Which courses would you like to include for therapist #4? *
Required
Therapist #5 *
Please include name, email, and license number
Which courses would you like to include for therapist #5? *
Required
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