Ready to Become a CHI Affiliate or Reseller?
Fill out the quick form below and our team will reach out with details, resources, and your exclusive partner welcome kit.
Affiliate/Reseller Application Form (Sample Fields for Developer)

Full Name
Clinic/Practice Name
Email Address
Phone Number
Practice Website or Social Media
Are you interested in:
[ ] Affiliate Program (earn commission per referral)
[ ] Reseller Program (buy at wholesale, sell direct)
Estimated Monthly Patient Volume
Tell us about your interest in CHI Institute products:
(Short text box)
How did you hear about us?
(Dropdown: Conference, Colleague, Social Media, Web Search, Other)
[Submit Button]
Direct link suggestion:
“Prefer to start right now? Apply here or contact our affiliate team at (800) 682-7061.”