Apply to Become an AwayMed Partner

Join the AwayMed network and offer your patients access to flexible financing options. Fill out this short form to start the partnership process.

Step 1 – Organization Type

Step 1 – Organization Type

Select the type of entity applying for partnership.

Step 2 – Authorized Representative Info

First Name *

First name of the authorized representative (doctor, director, or admin).

Last Name *

Last name of the authorized representative.

Title / Role

e.g., Owner, Medical Director, Administrator, Coordinator.

Phone Number *

Direct line or mobile of the authorized representative.

Email Address *

Official email for partnership correspondence.

Step 3 – Entity Information

Entity / Practice / Hospital Name

Legal or public name of your clinic, practice, or hospital.

Specialty

Select your primary specialty.

Address

Street Address

City

State

Country

Postal Code

Step 4 – Credentials & Verification

If Doctor / Physician

Cédula Profesional (License No.)

Enter your professional license number. DGP / SEP

Cédula de Especialidad / Certificación de Consejo

Specialty credential (if applicable) DGP / SEP / CONACEM

If Clinic / Hospital

Aviso de Funcionamiento / Licencia Sanitaria

Enter your COFEPRIS registration or license number.

Step 5 – Banking Information (for Wire Transfers)

Bank Account Holder

Legal entity name on the account.

Bank Name

Name of the financial institution.

Account Number / CLABE

Enter your 18-digit CLABE (for Mexico) or account number.

SWIFT / BIC Code

Required for international transfers.

Wire Transfer Instructions

Provide complete transfer instructions (Wise Business preferred).

I confirm that my clinic is licensed to operate in its jurisdiction, that I am authorized to submit this application, and I consent to receive SMS/email updates from AwayMed. Message/data rates may apply. Reply STOP to opt out.

Simple, secure financing for cross-border medical care.

Quick Links

Providers

Patients

Help

Contact Info

+1 (888) 857-4965

AwayMed LLC

30 N Gould St., Ste N

Sheridan, WY, 82801

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Disclaimer: Financing is provided by third-party lending partners and is subject to eligibility and approval. AwayMed is not a lender. Rates, terms, and approval decisions depend on the patient’s creditworthiness and are determined by our financing partners. Checking your eligibility will not impact your credit score. AwayMed acts as the merchant of record and facilitates your connection with approved financing providers. All medical services are performed by independent clinics; AwayMed does not provide medical care.