Partnership Qualification Form

Please fill out the form below

GreenMCMeds is a passion driven personalized preventative medicine company specializing in providing non-invasive innovational care and services to physicians and patients to enhance financial revenue for physicians and better the quality of life of patients, to whom we serve.

Do you currently have healthcare network?
What type of healthcare networks, please check all that apply:
PhysicianOffice Manager
Single Clinic (Single Physician/Multi-Physician)Chain of Clinics
Executive Officer (CEO, CFO, President, etc.)Physician
Executive Officer (CEO, CFO, President, etc.)Physician(s)
Executive Officer (CEO, CFO, President, etc.)Physician
Executive Director
Other Staff:
Have you worked with any providers in the network provided?

If yes, in what capacity?

Important: Non-Disclosure Agreement

You must fill out an NDA for your application to be processed. Please download the form, sign and initial, and email a copy back to

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DISCLAIMER: GreenMCMeds does not partake in cultivation or dispensing of cannabis in no way, shape, or form, nor are we affiliated with any dispensaries or cultivation sites.


“Your Health, Our Passion!”

Our Inspiration

Our Inspiration

Mon Chéri inspired us in her battle with brain cancer. Her fight helped us think differently about disease, prescription drugs and how knowledge is the key to prevention and treatment.


   (312) 838-2400

   233 East Erie Street, Suite #506
         Chicago, Illinois 60611