Required Information for your CDM TV Order Please complete all the fields to complete your CDM TV network activation: Clinic Name*Clinic Main Phone #*Clinic Main Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website* Contact Name* First Last Contact Direct Phone #*Contact Email* Subscription Type* Custom Streaming TV Channel (Roku or Browser): $25/mo Plus Media Player (if required) or Personalized Clinic Video Content: $35/mo Plus Media Player and Personalized Clinic Video Content: $45/mo Number of Subscriptions (1 per store rqrd)*Credit Card #*Name on Card*Expiration Date*MM/YYBilling Zip Code*Sec Code*CAPTCHA Have more questions?GET IN TOUCH Clear Digital Media. We help turn one-time visitors into lifetime patients. Contact 4909 Bell Springs Rd. Dripping Springs, TX 78620 tel: 877-999-4483 fax: 888-654-9219 Follow Us
