IV Therapy – New Elite Microsite Client (Demo)
Let's Get Started!
We are very excited to start generating new IV Therapy patient referrals for your clinic. Before we can begin developing your new microsite and directory listings, we need to learn a bit about yourself and your unique practice!
For optimal conversion rates and increased web traffic, we strongly recommend providing as much information about your practice as possible. All content submitted should be proprietary to your clinic, and a good representation of your practice.
For questions please call 800-775-0283 Ext. 101
*All fields with an asterisk are required.
What phone number would you like your incoming patient calls routed to?
This should be your primary office number so all calls from prospective patients can be connected to your staff.
What email address would you like your incoming email inquiries from patients sent to?
All online consultation requests will be automatically sent to the address(es) specified below. You may provide up to 2.
What is your current website URLs?
Please provide up to 2 website urls.
Your physical office address where you currently see patients
We will only market one location per membership.
Address Line 2
State / Province / Region
ZIP / Postal Code
Name of the practice.
Name of the featured provider.
Biography for the featured provider.
Please include number of years practicing, education, certifications, awards, advanced training and medical specialty/subspecialty.
Website theme requested.
Click image to enlarge.
Banner number requested.
Chose the word(s) that best describes your practice.
General Medical Practice
Provide the mission statement, medical philosophy and/or slogan of the practice. Describe what makes your practice unique.
Please list the IV Therapy protocols that you provide.
Please also provide, if available, additional information for each protocol to include in your marketing. Some common protocols offered may include High Dose Vitamin C, Immune Support, Detoxification, Hydration, and Anti-Aging. If you do not provide a list of protocols, common treatment information will be included in your marketing content.
Do you have IV Therapy patient testimonials?
Please provide the testimonials in the box below, or include a link to your IV Therapy patient testimonials.
Provider Photo and Practice Logo
Accepted file types: jpg, png. Upload limit for each image is 8MB.
Photo of provider
Please submit a professional high resolution head shot.
Membership Terms and Conditions
Ownership of Intellectual Property and Trade Secrets:
By signing our Subscriber Agreement, and completing this form, you hereby acknowledge that you agree to our policies on intellectual property, confidentiality and trade secrets as stated in our agreement. Please refer to these sections of your subscriber agreement for further understanding of our terms and conditions. We are very diligent in enforcing these policies. Please contact us if you have any questions.
I have read and understand the terms and conditions included in my membership agreement.
Once your form is submitted it will take our Web Development Department 7-10 business days to build your new microsite and directory listing. Once your microsite is complete, you will be notified via email by our Member Support Team. We appreciate you taking the time to provide us with the necessary content and information. We look forward to sending you many new patient referrals for years to come!
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