Physician Affiliate Application

Physicians Affiliate

Program Application

We’re thrilled at the opportunity to partner with you to bring accessible, patient-centered cannabis education to those who need it most.

At Gaia’s Gift, we believe in building genuine relationships with like-minded professionals who share our commitment to empowering patients through knowledge and wellness.

This program provides your patients with access to Green Wisdom Essentials at a significantly discounted rate, while also offering you a referral bonus for each patient who signs up using your unique affiliate code.

Thank you for considering this collaboration—we’re excited to explore how we can work together to make a meaningful impact on patient care.

First Name *

Last Name *

Title *

Phone *

Email *

Years in Practice *

Medical Speciality *

Average Age of Patients *

21 - 30

31 - 50

51 - 64

65+

How many cannabis patients do you see monthly, on average? *

What motivates you to provide cannabis education to your patients? *

How do you currently support patients in learning about cannabis? *

What specific challenges do you see your patients facing when it ocmes to cannabis use or education? *

If selected, what would you like your affiliate code to be? *

How did you hear about Green Wisdom Essentials? *

Is there anything else you'd like to share about your background or approach to patient care that might help us undersatnd your fit as an affiliate? *