Partnership For Pain Relief Sign Up Form

      By signing up below we can give you credit for any Infrex Plus or Tens unit purchases that occur from your referral of a friend.  When the form is completed you will receive your individual code, which you copy and can paste on your own web site, on a page of our site specific to you or your practice, or on a blog we will create for you.

     MedFaxx will place the code for you on either our site or your blog for Free.  Now when you refer a friend they will sign up for a free Infrex Plus trial to see if the unit helps them or not.  If the Infrex Plus helps then we bill the insurance company and upon payment remit the funds to you, your charity or our GJCAE charity. 

     By having your own referral account you will be able to keep an account of how much your referrals have generated for your charity. 

    After filling in the below information you will receive an email confirming you want to sign up and please reply back to that email.  This is done to prevent spammers from signing up and to prevent someone from signing your name when you did not sign up yourself.

     We will then set up your page on our site, create a blog specifically for you, or you can paste the code into your own web site and the tracking program will begin on any new referrals.


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*  Medicare and Medicaid patients are not included in the Partnership for Pain Relief.