Please fill out the form below. We will use the information from this form to prepare the actual Service Agreement. We will then send you the actual service agreement and credit card processing form.
Billing same as business
Provide two email addresses ChiroSpring will use to send you information.
Do you need existing patients imported into ChiroSpring?
Need Patients Imported Into ChiroSpring*
No - I do not need patients imported into ChiroSpring
Yes - I need patients imported into ChiroSpring
Will You be Using Integrated Payments?
Using Integrated Payments*
No - I am okay using my own processing solution and will add $100/Mo to my ChiroSpring fee
Yes - This saves me $100/Mo and offers many benefits including a great rate!
ChiroSpring’s Integrated Payments offer huge benefits and SAVINGS to our customers. We will meet or beat your current processing rate including Square, PayPal and much more!
List All Users You Would Like Added to ChiroSpring.
Physical Therapist Medical Doctor
Physical Therapist Nurse Practitioner
Referral Program (Who were you referred by?)
By existing ChiroSpring customer
How Did You Hear About Us? *
Chiropractic Economics Magazine
Practice Insights Magazine
The American Chiropractor Magazine
Palmer Insights Magazine
National University Event
Using ChiroSpring with a Mac, PC or Both?
Using ChiroSpring with a Tablet?