Online Account Information

Your Email Address (required).

Choose your Login User Name to Sweed (required)

Choose your Login Password to Sweed (required)

Member Information

Your Full Name (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone Number (required)

Mobile Phone Number (required)

Date of Birth (required)
Example 01/01/2015

Valid ID/Drivers License No. (required)

Valid ID/Drivers License Expiration Date (required)
Example 01/01/2015

Member Identification Upload

Upload Valid Drivers License/ID (required)

A scanned copy or picture. Valid original will be verified upon initial member consultation if approved.

Medical Information

Medical Recommendation Expires on: (required)
Example 01/01/2015

Medical Registry No. / Patient No.

Your recommendation number, patient number or registry number.

Who is your Caregiver?

If applicable or leave blank for none.

Who is your Doctor / Physician?

Doctor / Physician License No.

Leave blank if you do not know.

Medical Condition

Medical Symptoms

Verification Website

If applicable or leave blank for none.

Verification Phone Number

If applicable or leave blank for none.

Medical Document Upload

Upload Current Medical Recommendation (required)

A scanned copy or picture. Valid original will be verified upon initial member consultation if approved.

General Information

Please select your preferred medical products: (required)

Select all that apply so we may further understand your needs as a patient member

How did you hear about Sweed?

Were you referred by an existing Member? If so, who?

Referring members receive an extra 'Thank You' from the cooperative.

Member Agreement

Terms and Conditions

Security Verification

Enter the Security Verification Code (required)
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