Join MediGroup

Participation Agreement

  • Member Primary Location

  • Member Details

  • Physician PracticeClinicSurgery CenterOther
  • Location 2

  • Location 3

  • Location 4

  • Location 5

    • Distributor Details

    • Primary Contact Person (the individual who will receive updates from MediGroup)

    • Signer Details

    • Most utilized additional discounts: (Optional) Select the program discounts you are interested in and we will send you the details. A complete list of ancillary discounts will be sent to the designated contact once enrollment is complete.

    • AT&TVerizon
    • AirgasPraxair
    • GSKMerckSanofi
    • ShredIt
    • StaplesOffice Depot
    • MedPro DisposalStericycle
    • Enterprise/National Rent a Car
    • FedEx
    • ImagingTablesOther
    • YesNo