Please fill out the following medical intake form before your consultation. Please be as honest and accurate as possible. Our medical providers will use the information to determine your best course of treatment.
Please note that there is a fee for your consultation with the provider. The NLE fee will cover your provider visit and may range anywhere between $150 and $300 depending on your state. There may also be additional fees due to the state in order to receive your card, depending on your state. If you have any questions, we will be happy to answer them for you once you have filled out your enrollment form. We look forward to having you as a part of the NLE Family!
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IF YOU DO NOT HAVE A FLORIDA DRIVER'S LICENSE AND ARE APPLYING IN THE STATE OF FLORIDA, PLEASE CONSIDER GETTING ONE BEFORE APPLYING. If you do not, the state will REQUIRE more documentation. They need TWO proofs of residency. If you have a Florida driver's license and are applying for Florida, this will not apply to you as your driver's license will be sufficient.
IF YOU DO NOT HAVE A FLORIDA DRIVER'S LICENSE FOR A FLORIDA APPLICATION, YOU MUST HAVE TWO OF THE FOLLOWING IN YOUR NAME SHOWING YOUR FLORIDA ADDRESS.
1) Current water bill
2) Current Electric bill
3) Mortgage
4) Leasing agreement (must send ALL pages)
5) Bank statement
Additionally, they will require a headshot against a plain white or off white wall (so it resembles a passport photo).
All documents and the photo can be emailed to [email protected].
Once these documents are received, we will be able to proceed with your application.