Home | Affiliate Toolkit

Affiliate Application

Have all information you need and ready to move forward? Complete the application and sign the affiliate referral agreement.

DPC Application

Are you a DPC and would like to offer Co-Op Direct Memberships to your patients? Complete the application and sign the affiliate referral agreement.

Referral Partner Application

Are you working with a Health Access Affiliate? Please complete the application.

Affiliate Rep Application

Are you an Affiliate Rep working with a Referring Affiliate? Complete the application and sign the affiliate rep agreement.

New Group Submission

New Group Submission (SG/3^rdparty enrollment system)

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About being a share holder

Use this paragraph to describe what you do. This is a great place to let your visitors know who you are. Add useful information that your users may find interesting. What makes you stand out?

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Think long-term