Patient Focused Certification Application Form

For your free quote, please completely fill out the application below.  Upon completion, and submitting the application, your company’s information will be securely transmitted to PFC staff.  You will automatically receive a confirmation email verifying that PFC has received your application and inviting you to create a secure PFC client profile where you can safely view and store documents to track your company’s certification process. Within 7 business days, PFC staff will send you a price quote and contract that will list the responsibilities of all parties involved including financial obligations, nondisclosure agreements and acceptance of terms.


Business Trade Name (required)

Business Legal Name (required)

Mailing Street Address (required)

City (required)

State (required)

Zip (required)

Contact Name (required)

Contact Email (required)

Phone (required)

Number of Facilities (required)
For organizations with multiple locations please fill out Additional Locations section at the end of the application

Number of Employees (required)

Standard Operating Procedures
We have documented our Standard Operating Procedures

A. Services Requested (required)

Advisory ServicesPre-Licensing CertificationIndustry Certification

B. Facilities to be Certified
Types of Certification Sought


C. How many square ft of cultivated space (if applicable)

D. Please describe the types of products to be manufactured (choose all that apply)
Extracts/ConcentratesEdible or Ingestible ProductsTopical Products

We manufacture a non-medical-marijuana variant of our product(s) at the same facility

Additional Product Information

E. Licensing

Please describe the state and local licensing or registrations relevant to your operations. Please note if no licenses are available for your operation.

F. Machinery and Infrastructure

Please describe the major machinery, software and infrastructure used in your operations. This might include inventory and tracking software, manufacturing equipment, trim machines, etc.

G. Subcontractors

If applicable, please list any sub-contractors used in your operations including name and the activities they perform. Examples of sub-contractors include the nursery that provides the companies propagation material. Or, if manufacturing edible products the name of the company who supplies your company with extracted cannabis products.

H. Quality Consultants

Please list any consultants, including name and address, used to develop your quality systems or operating procedures.

I. Other Certifications

Please list any certifications, past or present, your operation has received and the name of the certifying organization. If cancelled or no longer current, please describe why.

J. How Did You Hear About PFC?

K. Organization Affiliation

Companies with membership in AHPA, various trade organizations, or those under UFCW contracts are eligible for discounts. Please list any of these types of organizations of which your company is a current member. Choose all that apply.

If you belong to an organization or association whose members would benefit from a discount, please contact us for details.

L. Additional Locations

Please list the name of the facility, the city, state and zip code and number of employees of any and/or all additional facilities

All application information shall remain CONFIDENTIAL. Based on the information contained in this application, PFC will prepare a no-obligation offer for certification. If PFC staff requires additional information to generate a quote a representative will contact you directly via email.