Join MediGroup

Participation Agreement

  • Member Primary Location

  • Member Details

  • Primary Facility Type
  • Location 2

  • Location 3

  • Location 4

  • Location 5

    • Distributor Details

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

    • Signer Details

    • Same as Primary Contact Person Above
    • 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.

    • Wireless Services
    • Medical Gases
    • Vaccines
    • Document Shredding
    • Office Products
    • Waste Disposal
    • Car Rental
    • Freight Management
    • Capital Equipment
    • Any Location(s) new construction?