Become an affiliate

Step 1 of 4

Your Personal Information
Payee Name*
Enter the name exactly as it should appear on the check. If the check is to be mailed to an individual other than the Payee, enter the name of the recipient in "Address 1" below
First Last
Phone*
Your Email Address*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Who is the main contact for this account?*
- The payee listed above
- Someone else - I need to enter their information
Contact Name*
Contact Phone Number*

Website and Mobile App List
List all the top-level websites and /or mobile apps on which you plan to display banners, widgets and other digital assets. You need to add at least one website or mobile app.
Enter Your Website(s)
Enter Your Social Media URL(s)

Additional Information
What is your preferred Referral ID?*
(This is an alphanumeric ID of your choosing, with no special characters or spaces.)
Tell Us About Content you create*
How did you hear about us?*

Affiliate Agreement
This Agreement ("Agreement") is made and entered into as of*
By and between Assist Health Corporation, a Texas Corporation ("Company"), and*
RECITALS:

WHEREAS, the Company operates a e-commerce platform and desires to engage the AFFILIATE for the purpose of promoting the platform to consumers and other businesses that may utilize the platform (“Customer”) via social media and other digital avenues; and WHEREAS, the AFFILIATE agrees to provide such marketing services on the terms and conditions set forth herein.

AGREEMENT:

Engagement: The Company hereby engages the AFFILIATE, and the AFFILIATE hereby accepts such engagement, to act as an independent contractor to perform the services described herein.

Services: The AFFILIATE agrees to create and share content related to the Company’s products, including posts, stories, and videos on social media, websites, or blogs, as specified in this Agreement.

COMPENSATION:

The AFFILIATE shall be entitled to commissions on all sales generated through their unique referral links or promo codes provided by the Company, as outlined in Exhibit A attached hereto and made a part hereof.
Commissions will be calculated based on the net sales amount, excluding taxes, shipping, and handling fees. Payments will be made on a Monthly basis, within 30 days of the end of each period.
Commission Duration: The commissions shall be paid to the AFFILIATE during the term of the Agreement.
Terms and Termination: This Agreement shall commence on the date hereof and shall continue and stay in effect until terminated by either party upon written notice. Company reserves the right to modify the compensation amount as well as discontinue or terminate the AFFILIATE agreement at any time.
Healthcare Disclaimer: The AFFILIATE acknowledges and agrees that they are not involved in the provision of healthcare services to any referred customers. The Influencer is not a referring physician or healthcare provider for any referred customers and will not gain from this agreement for patients under the care of the AFFILIATE.
Independent Contractors: In the performance of the duties and obligations imposed under this Agreement, it is mutually agreed that AFFILIATE at all times shall be, acting as an independent contractor engaged in the business of furnishing Services to AHG. AHG shall neither have nor exercise control or direction over the methods by which AFFILIATE shall perform their duties and obligations arising hereunder. This Agreement is not, and shall not be considered, an employer-employee relationship, joint venture or partnership of any kind, and neither party shall represent to any third persons that any such relationship exists.
Representations and Warranties: The AFFILIATE represents and warrants that they will comply with all applicable laws, regulations, and guidelines, including but not limited to FTC guidelines for endorsements and testimonials. The AFFILIATE warrants that the content created will be original and will not infringe on any third-party rights.
Indemnification: The AFFILIATE agrees to indemnify and hold harmless the Company from any claims, damages, losses, and expenses arising out of the AFFILIATE's breach of this Agreement or the AFFILIATE’s negligence or misconduct.
Confidentiality: The AFFILIATE shall maintain in strict confidence all confidential information of the Company and shall not disclose such information to any third party.
Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the State of Texas. Should either party employ an attorney for the purpose of enforcing this Agreement, or any judgment based hereon in any court, including bankruptcy court, courts of appeal or arbitration proceedings, each party shall be responsible for its attorneys' fees and costs.
Defamation: The AFFILIATE agrees not to make any statements or comments, whether orally or in writing, that could defame, disparage, or in any way criticize the Company, its products, services, business practices, directors, officers, agents, employees, or affiliates. The Influencer agrees to remove any such statements immediately upon the Company’s request.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written.
Date of Agreement*
Affiliate Signature*

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About Assist Health Group

Since 2010, Assist Health Group has offered high quality specialty managed care and disease management solutions through its concierge program. Our services are designed to be customer driven and outcome based.

By focusing on maintaining a high quality of care, providing the best customer and provider service, and building strong relationships with our providers and payors, Assist Health has developed an innovative PPO network solution that provides the benefits for patients, providers and payors.

Become an affiliate

Step 1 of 4

Your Personal Information

Website and Mobile App List

Additional Information

Affiliate Agreement

RECITALS:

AGREEMENT:

COMPENSATION:

Patients

Providers

Organizations

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