Physician Application

Miracle Leaf Health Centers is a Medical Marijuana Clinic that provides high quality evaluations to patients seeking the use Medical Marijuana as a form of medicine. Our company is a franchise that has location throughout South Florida but we are expanding north bound quickly as well. We are relatively new to the industry but have already taken the community by storm having several large media outlets cover us and integrating ourselves directly into the community by our outreaching efforts to educate and empower the population that makes up our beautiful cities.

At this time our volume of patients has superseded our expectations and we are looking to bring aboard certified quality Physicians that place the utmost importance on patient care and experience. We are looking for support for the current clinics that are operational but are also in need of Physicians with traveling and scheduling flexibilities who will segue into the new franchised clinics that are already under development.

We are passionate about this form of care that heals and alleviates the individuals that use it so greatly and are willing to share our vision and success with those Physicians who are equally as invested and passionate. Our clinics meet all HIPPA and the Department of Health regulations, are equipped with all necessary devices and software and have a streamlined process that facilitates every facet of operations seamlessly. The vision, model and structure is there… All we need is you!

If you’re currently a Medical Marijuana Certified Physician who would like to gather more information to come aboard, please take a moment to fill out the application below!

If you have any questions please connect with us via phone (786)953-8026 and one of our team members will reach out shortly to determine eligibility and compatibility in scheduling, compensation, experience, etc.

Apply Now

Name
First Last
Application Date
MM slash DD slash YYYY
Preferred Address For Miracle Leaf Health Center Correspondence
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Languages Spoken
Professional Information
Current Position
Medical School Of Graduation
Dates Attended
MM slash DD slash YYYY
Residency Program
Dates Completed
MM slash DD slash YYYY
Program Director
Fellowship Program (If Applicable)
Dates Completed
MM slash DD slash YYYY
Work Related References
(Please List Two Who Can Attest To Your Specific Medical Abilities And Have Worked With You In The Last Two Years)
Reference 1
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Number
Occupation
Reference 2
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Number
Occupation
Board Certified
- Yes
- No
Specialty
Where Taken
Date
MM slash DD slash YYYY
Board Eligible
- Yes
- No
Specialty
Where Taken
Date
MM slash DD slash YYYY
Complementary Information
DEA Registration Number (If Applicable):
Current Medical License Number:
Date Of medical Marijuana Certification:
Current Experience
- Pediatric (0-6 Years Old)
- Pediatric (7-14 Years Old)
- Adult (Over 14 Years Old)
(Please Indicate Which Types Of Patients/Programs With Which You Have Had Experience In The Last Five Years)
Please Answer The Following Questions (Choose One):
1) Are You Now Or Have You Ever Been Involved In Any Litigation, Lawsuits, Claims, Or Arbitration, Or Are You Now Involved In Any Threatened Litigation Or Claim Related To Your Professional Activities?
- Yes
- No
2) Have Judgements Or Settlements Been Made Against You In Professional Liability Cases Or Are You Involved In Any Pending Litigation Or Denied Liability Insurance At Standard Rates?
- Yes
- No
3) Have You Ever Been Denied Liability Insurance?
- Yes
- No
4) Has Your Membership Or Renewal Thereof In Any Medical Organization Ever Been Revoked, Suspended, Diminished, Or Denied?
- Yes
- No
5) Have Your Privileges In Any Hospital Ever Been Suspended, Diminished, Revoked, Denied Or Not Renewed?
- Yes
- No
6) Have You Ever Been Charged With Any Crime Other Than Minor Traffic Violations?
- Yes
- No
7) Has Your License In Any Jurisdiction Ever Been Limited, Suspended, Or Revoked?
- Yes
- No
8) Has Your Federal DEA Registration Ever Been Limited, Suspended, Or Revoked?
- Yes
- No
9) Have You Ever Been Subject To Any Disciplinary Proceeding Or Action By Any Employer, Hospital, Or Other Entity Or Institution With Respect To Your Professional Activities Or Behavior?
- Yes
- No
10) Have You Ever Received Treatment, Voluntarily Or Involuntarily For Alcoholism Or Drug Abuse, Mental Illness Or Psychiatric Problems?
- Yes
- No
11) Do You Have Any Current Or Past Health Problems Or Conditions That Would Impact Or Limit Your Ability To Practice Medicine Currently?
- Yes
- No
I Certify That The Information On This Application Is True To The Best Of My Knowledge. I Authorize All Persons And Institutions To Disclose To And Share With Miracle Leaf Corp Opinions And Information Regarding Me, Including But Not Limited To, Information Contained In This Application And My Skills, Experience, Fitness To Practice Medicine, Character, Work Habits, And Performance.
- Agree
I Certify That The Information On This Application Is True To The Best Of My Knowledge. I Authorize All Persons And Institutions To Disclose To And Share With Miracle Leaf Corp Opinions And Information Regarding Me, Including But Not Limited To, Information Contained In This Application And My Skills, Experience, Fitness To Practice Medicine, Character, Work Habits, And Performance.

Physician Application

Apply Now

Physician Application

Professional Information

Work Related References

Complementary Information

Please Answer The Following Questions (Choose One):