This is where your health journey begins.

Panoxol Brand Partner Enrollment form

Congratulations for taking the step to building your coaching business to higher levels. In addition to consulting with your clients regarding exercises and nutrition you can help them have more energy and recover fast from exercise.

Affiliate Registration

This form must have an email field.

Name(Required)

First Last

Email(Required)

Phone(Required)

Zip Code(Required)

Business Name

Website

Business Logo

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 15 MB, Max. files: 5.

Profession

Health Coach

Personal Trainer

Medical Doctor

Other

Short Bio

Hidden

Certifications

If you have a certification that does not have a paper certificate, please list here

Certifications

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Accepted file types: pdf, jpg, png, Max. file size: 15 MB, Max. files: 5.

If you have a certification that does not have a paper certificate, please list here

Certificate (Title)

Completion Date

Validity Period

Date Renewed

Insurance Requirement

Please upload insurance verification. If you only use a waiver that your clients sign, please attach a copy of the waiver/contract.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 15 MB, Max. files: 5.

Headshot(Required)

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 15 MB, Max. files: 5.

Please select a day and time window so that we may set up a meeting to welcome you to the program. If you don't select a day/time, we will call you when we can.

Preferred day of contact

Monday

Tuesday

Wednesday

Thursday

Friday

Anytime

Preferred time of day

9:00-11:00am (EST)

11:00-1:00pm (EST)

1:00-3:00pm (EST)

3:00-5:00pm (EST)

5:00-6:00pm (EST)

There is a one-time Affiliate Sign Up Fee of $399. Proceed to cart to complete the sign up process.

AS SEEN ON

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DISCLAIMER

These statements have not been evaluated by the FDA. This product is not intended to treat, diagnose, or cure any disease.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

Clinical and Herbal Innovations, Inc.
206 N. Washington Street,
Suite 100 Alexandria, VA 22314-2534

Here’s the deal: If you sign up for a monthly subscription to receive Panoxol, we will send you the first bottle FREE. There is a $15 one time signup fee which covers the shipping and handling cost of that free bottle. You can cancel at any time. All we ask is that you give it a try. If it doesn’t work for you, keep the bottle or pass it on.

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