Partner With WellClub™

Expand your digital practice and reach more patients with WellClub™. Complete this application for consideration to join our network of trusted healthcare providers.

Full Name

Credentials

Practice/Clinic Name

Specialty/Practice Focus

Years in Practice

NPI Number

State

Postal code

License Number

Do you currently offer telehealth services?

Phone *

Services You Want to Offer on WellClub™

Email *

I agree to uphold WellClub™’s standards of patient care and professionalism, and to comply with all applicable healthcare, telehealth, and in‑person practice regulations.

I confirm that I am a licensed medical doctor (MD/DO) authorized to practice in the listed state(s). I understand WellClub™ is a marketing and referral platform and does not provide medical services directly.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.