Our Program
|
About The Academy
|
Costs & Stats
|
Forms
|
Quick Links
|
Testimonials
|
FAQs
New patient referrals to our clients:
Demo
Referrals as of
Demo
SignUp
About Us
Contact Us
Login
Course Dates
Search
Search
New to the site?
Please fill in the information below and click next.
×
Signups
id
date time
First Name
Last Name
Email
Fax Number
Mobile Phone
SMS Messaging
By entering my mobile number and checking the "I want to receive SMS Messages" box I agree to Opted to receive academic and training programs from the Academy of Chiropractic. Message frequency varies. Text HELP to 97184 for help, Text STOP to 97184 to end. Msg&Data Rates May Apply. By opting in, I authorize Academy of Chiropractic to deliver SMS messages using an automatic telephone dialing system and I understand that I am not required to opt in as a condition of purchasing any property, goods, or services. By leaving this box unchecked you will not be opted in for SMS messages at this time. Click to read
Terms and Conditions, Privacy Policy
Mobile SMS Opt-in
I want to receive SMS Messages
I Do NOT want to receive SMS Messages
Phone
Address 1
Address 2
City
State
Zipcode
Country
Practice name
Paid
No
Yes
Instructions
Credit Card Payment Fee: $225 plus $225 Setup Fee*
Checking Account Debit Fee: $199 plus $225 Setup Fee*
Credit Card or Debit
Credit Card
ACH
Card Number
Expiration Date Month
1
2
3
4
5
6
7
8
9
10
11
12
Expiration Date Year
2024
2025
2026
2027
2028
2029
2030
2031
Account Type
Checking
Savings
Routing Number
Account Number
Name On Account
Bank Name
address
Next >
Home
About Us
Blog
Log In
Course Dates
Our Program
Costs & Stats
Forms
Quick Links
Testimonials
FAQs
Contact Us