We are super excited for you to become the newest member of the ChiroCloud community.
Complete this short form and you will be up and running.
Please enter all information carefully. These exact values will be used to create your account.
1Practice Information
Practice Name
Practice Address
Suite or Office Number
City
State
Zip
Primary Contact Person
Phone
Email
2Users
Add each staff member in your office. Everyone will have a seperate login. Take care to enter email addresses correctly. Wrong addresses will prevent users from setting their password. If you can't remember someone's email you can always add them later.
Add User
3Package
ChiroCloud works on pre-payment. You pay a $100 service fee for 30 days of credit. After available credit runs out you will be asked to enter a credit card to buy more credit.
1 Month @ $100/Month
$100
6 Months @ $100/Month
$600
12 Months @ $100/Month
$1200
+ Sign Up *
$1995
Total
$10000
Promotion Code
Validate Code
4Payment
Name (as it appears on card)
Card Number
Expiration Date
Security Code
Billing Address
Suite or Office Number
City
State
Zip
5How did you get here?
What excites you most about ChiroCloud?
Where did you first hear of ChiroCloud?
Did anyone assist you with this purchase?
Who?
Sign Me Up!
When you click Sign Me Up! your card will be charged . You are also agreeing to our Terms of Service and our Privacy Policy.
*ChiroCloud's sign up fee is non-refundable after 7 business days. Refunds will be deducted an average of a 3% transaction fee. All requests for refund will need to be sent by the primary cardholder to sales@chirocloud.com.