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Posting a request for medical care on MediBid.com is free if you do not receive any Bids. To browse through matched providers and to view your Bids, there is a service fee of $25 per medical request posting (not per Bid received).
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Personal Information
First Name:
Last Name:
Email Address:
Phone:
Alternate Phone:
Address Line 1:
Address Line 2:
City:
Country:
- Select Country
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Zip or Postal Code:
(Use only first 5 digits for United States)
Gender:
Male
Female
Date of Birth:
Month
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/
Date
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/
Year
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1925
Referred By:
Your Present Health Condition
Do you have cardiac problems?
Yes
No
Do you have respiratory problems?
Yes
No
Do you have diabetes?
Yes
No
Do you high-blood pressure?
Yes
No
Do you have allergies?
Yes
No
If Yes, please list allergies
Do you smoke?
Yes
No
If Yes, how many years
Do you consume alcohol?
Yes
No
If Yes, how much
Current Medications
Height (ft, in)
Weight (lbs)
Are you enrolled in U.S. Medicare?
Yes
No
If yes, are you enrolled in (check all that apply):
Part A
Part B
I have read and agree to
Terms of Use
.
By checking here, you have read and agree to the above terms and conditions and agree that you, not MediBid, are responsible for any background checks on any of the health care bidders accessed through this site. If you are a doctor, bidding on services, you further warrant that you are licensed, board certified, and not under disciplinary action and competent to provide the services on which you are bidding.
Registration is FREE. You can also create your medical request for free, you will need to pay $25 in order to see the bids and view the profile of the bidder, who bids on your request.
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