Patient Focused Certification Application Form

For your free quote, please completely fill out the application. 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. 


For organizations with multiple locations please fill out Additional Locations section at the end of the application

Standard Operating Procedures

A. Services Requested (required)

B. Facilities to be Certified

Types of Certification Sought

D. Please describe the types of products to be manufactured (choose all that apply)

E. Licensing

F. Machinery and Infrastructure

G. Subcontractors

H. Quality Consultants

I. Other Certifications

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

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.

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