Payson Wellness
  • Home
  • Practitioners Connection
    • Facilities
    • Register
    • Reservations
    • Payment
  • Wellness Connection
  • Unity Connection
    • Contact Us

Practitioners Application & Webpage Registration Form

NOTE to PRACTITIONER:   Use this form to apply to become a member.  Only fill out form if you have already visited the PRACTIONERS CONNECTION page and have read the INTEREST & REGISTRATION FORM.  If you are unsure then CONTACT US.

    If your business has a name enter it here, otherwise just type "none".
    What are you licensed in or what are your qualifications?
    Primary contact name
    Enter your mailing address
    How long have you been in practice or providing your service?

    Complimentary Webpage Information:

    The information below will be included on your complimentary webpage provided with your membership, so please make sure you type correctly, and write exactly the words you would like your page to say.
    The number you would like listed on your business page
    Email you would like your clients to use
    If your business has it's own website enter here, otherwise type "none".
    Is there anything else you would like to share on your page?
    Write a brief paragraph or two of the services that you provide.
    UPLOAD A LOGO & PHOTO or an image to represent your business. Preferred Files (.jpg  .png or .pdf)
    Max file size: 20MB
    Max file size: 20MB
    Upload a photograph of yourself
Submit
Picture

200 W. Frontier St., Suite S - Payson AZ  85541
CONTACT US
  • Home
  • Practitioners Connection
    • Facilities
    • Register
    • Reservations
    • Payment
  • Wellness Connection
  • Unity Connection
    • Contact Us