Survey

Risk Free! See if you qualify.

A recommendation is available to Florida residents who have been diagnosed with a qualifying condition. Simply complete the confidential eligibility survey, schedule an appointment with one of our Florida licensed and certified physicians who will immediately provide your recommendation. Get your card right away, don't wait any longer!

Fill out this eligibility survey to see if you qualify:

First Name

Last Name

Phone

Date of Birth (mm/dd/yyyy)

Zip Code

Are you a Florida resident?

Have you received previous treatment for your condition? e.g. medication, surgery, counseling

How did you hear about us?

Please check any of the conditions you suffer from:

Electronic Communications: By using ChoiceMedGroup's website, telephone, facsimile, send text messages or emails to us, you are communicating electronically. You consent to receive communications from us electronically. We will communicate with you by telephone, email, text message or by posting notices on this site. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.