* First Name Last Name Email * Professional Title and Credentials * Brief Description of Your Practice * Why Are You Interested in Becoming an Affiliate? * Please check all the apply Enhance client care with comprehensive weight loss support Collaborate with a physician-led program Offer additional resources to my clients Interested in earning affiliate revenue Other Thank you for your interest in becoming a Shift Program affiliate. We are excited to hear from you. Someone from the Shift Team will be in touch shortly. Have a great day! Dr. White and the Shift Team.
