Academy of Chiropractic’s

MD Relationship Program

From:  William J Owens Jr DC DAAMLP


Thank you for making the decision to build your practice with MD Referrals, this is a very important step and is critially important to your success as a Doctor of Chiropractic!  I am very excited to work with you and help build a network of medical referrals in your community. This a fun and rewarding process.  Below are two links that are important to signing up, the first is the ONE PAGE Agreement which outlines the Administrative aspects of the program and the second link is for the Payment option.  Once BOTH items are received at our office, my office manager will send you the “Getting Started Guide” and your username and password for this website.  PLEASE make sure that you read the ENTIRE “Getting Started Guide” before you do anything, it will help you to understand the FIRST STEPS to be successful in this program as well as the best way to communicate with me.  Let’s get started together! 



In this section, please print or type the information requested into the BOTTOM section of the Agreement and fax or scan/email back to the fax number at the bottom.  



In this section, we would recommend the ACH/Bank Draft for the $199 per month fee.  This allows us to keep costs down since we don’t have to constantly chase expired cards or cards that have been compromised.  Thank you for your consideration.   




William J Owens Jr DC DAAMLP 




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