Partner & Healthcare Practitioner Application

Partnership Type - Please choose one *Partner - I would only like to share product links and receive commissions on sales I referHealthcare Practitioner (HCP) - I see clients 1:1 and I would like sell physical product in my office and/or drop ship to my clientsHCP Combination - I would like to do both of the aboveAmbassador - I would like to promote Healthy Gut products to my audienceDistributor - I would like to sell Healthy Gut products in my brick and mortar store and/or ecommerce store

First Name *

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Who will be the primary contact for your account? (Please list their first & last name, along with their title within the company) (optional)

How did you hear about Healthy Gut? *

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SMS Text Opt-In (optional)YesNo

Business or Practice Name *

Website *

How would you best describe your business? *Functional Medicine PracticeHealth Coaching PracticeHealth EnthusiastOther

Can you share a little bit more about who your clients and community are? *

Social Media Handles (optional)

Do you have a Health/Wellness Podcast? *YesNo

Preferred Communication (Please let us know your preference for communicating with you about your Healthy Gut account) *EmailPhoneSMS Text

How will you share HG products? *1:1 ProtocolsWebsiteSocial MediaBlog / NewsletterOther

What is your licensure/certification? State NA if applicable *

License - Upload a copy of your active license (Allowed File Types: doc,docx,xls,xlsx,pdf,jpg,jpeg,png,gif,txt)

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