Ft. Myers, Florida — (239) 333-3340 (change)

Request for Information

Complete this form to contact
our business development team.

Franchisee Qualifications

Applications must meet the following basic requirements to be considered for a Medi-Weightloss Clinics^® Franchise:

Liquid assets above $350,000
Net worth of approximately $1,000,000 or higher
Physician or physician group with an existing patient base
Investors are welcome if they have a physician or physician group with a patient base to partner with
A commitment to protecting and enhancing the Medi-Weightloss Clinics^® Brand

Thank you for your interest in becoming a Medi-Weightloss Clinics^® Franchisee. Please complete the form below, and a member of our Business Development team will contact you.


First Name		Middle		Last Name
Home Address
City			State			Zip Code
Phone	Best time to call		Fax
Email

How did you hear about Medi-Weightloss Clinics^®? OBGYN.net OBGYN News Internet Internal Medicine News Current Medi-Weightloss Clinics^® Franchise Owner OBG Management Other (please specify below)
Details/Other

Are you a physician? Yes No			Are you in a group practice? Yes No
			How many physicians?		How many patients?

Have you ever had experience with a franchise? Please explain.
Have you ever owned a business before? Please explain.

Where are you interested in opening a Medi-Weightloss Clinics^® Franchise?
Second Choice

When would you like to start your business? 3 - 6 months 6 - 12 months 1 year or more

What is your approximate net worth? $250,000 - $499,999 $500,000 - $999,999 $1,000,000 +
How much in liquid assets do you have available for investing? (Not including 401K or IRAs) $0 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 +

Will you have investors/partners? Yes No
How much in liquid assets do your partners have available for investing? (Not including 401K or IRAs) $0 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 +

You have indicated an interest in purchasing a franchise for the development and operation of one or more Medi-Weightloss Clinics^®. The information requested from you in this document is for the exclusive use of Medi-Weightloss Clinics^®. Unless we agree to waive this requirement, you must provide all of the information requested before your application will be considered.

Franchise Disclosure Document

This notification is to inform you that our FDD is available in multiple formats.


When it is time to receive our FDD (Franchise Disclosure Document), which format would you prefer? Hard Copy (paper copy) PDF via Email; you must have an email account capable of receiving large attachments, email software, and Adobe Acrobat software to view the FDD.

^† On average, Medi-Weightloss Clinics^® patients lose 7 pounds the first week and 2 to 3 pounds each week thereafter for the first month. Rapid weight loss may be associated with certain medical conditions and should only be considered by those who are medically appropriate.

Request for Information

Complete this form to contactour business development team.

Franchisee Qualifications

Franchise Disclosure Document

Complete this form to contact
our business development team.