Terms of Acceptance

I accept the following terms:

By checking off each of the following, you are agreeing to the terms and conditions herein. You MUST agree to all terms for us to approve your Dr. appointment.

My appointment is for a: *
Card Delivery *

The Greener Institute is providing our patients with a streamlined process that expedites the delivery of the cards.

Appointment Time *
State Account *
If we are setting up your account:
State Certification Emails — If the Greener Institute is setting up my account

Once you are certified by the doctor, the State will send the following 3 emails:

State Certification Emails — If I set up the state account
Renewal *
Fees *
Refund Policy *
Digital Signature *

By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature and consent to be legally bound by this agreement's terms and conditions.