ASHLEY & MARTIN PATIENT’S CENTRE

YOUR REFERRAL PORTAL

Ashley & Martin now rewards our existing patients for spreading the word about our hair loss treatment… whenever a friend you have mentioned us to enrols as a patient, you receive $300 OFF YOU NEXT RE-ENROLMENT! Refer six friends and your enrolment is free!

There are some simple but important rules to follow:

- Only fill out the referral submission form on this page when you hear your friend has enrolled as a patient and entered into a contract with Ashley & Martin.
- Seven working days after your referral submission is received we will double check the validity of the referral. We will then email you a confirmation the referral has been accepted or rejected. The referral fee only becomes claimable when this process is complete and you have received your confirmation email.
- You cannot claim referrals at your clinic, it can only be done online using the form below.
- If you refer more than six patients, any referrals in addition to the first six will be allocated to the following year’s re-enrolment.
- For full details on the requirements, see the Terms and Conditions

CLAIM $300 OFF YOUR NEXT RE-ENROLMENT

Unique ID
Your First Name*
Your Last Name*
Your Clinic*
Your Email*
Your Mobile Phone Number*
First Name of the Person You Referred*
Last Name of the Person You Referred*
Mobile Phone Number of the Person You Referred*
Email of the Person You Referred (Optional)
Their Clinic (If Known)
Terms*
- I have read and agree to the Terms and Conditions and confirm the person I have referred has entered into a contract with Ashley & Martin

ASHLEY & MARTIN CLINIC CONTACT DETAILS