Home Care Membership

Enroll in the MDHC Home Care Membership

Complete this secure form to start your MDHC Home Care Membership. You will be redirected to a secure Stripe checkout page to enter your payment details.

Patient Information

First Name *

Last Name *

Date of Birth *

Mobile Phone *

Email Address (for receipts & portal access) *

Service Address

Address Line 1 *

Address Line 2

City *

State *

ZIP Code *

Membership Options

Billing Preference *

Reason for joining / key concerns (optional)

Agreements & Consent

I have reviewed and agree to the Membership Subscriber Agreement.

I acknowledge receipt of the HIPAA Notice of Privacy Practices.

I have reviewed and agree to the Financial Responsibility Policy.

I have reviewed and consent to the Telehealth Consent.

I certify that the information provided is accurate and that I am the patient or legally authorised representative.

I understand this membership requires a minimum 3-month commitment and renews monthly thereafter until cancelled in accordance with the Membership Cancellation Policy and Membership Subscriber Agreement.

Type your full name as your electronic signature *

By typing your name, you are electronically signing this agreement.

You will be redirected to Stripe’s secure checkout page to complete your enrollment.

Membership Summary

$299 / month

3-month minimum commitment. No enrollment fee.

Assigned primary provider whenever possible.
1 included home visit per month.
Unlimited member telehealth visits.
Medication management and care coordination.
Preventive care planning.
Hospital follow-up and specialist referral coordination.
Additional home visits may be requested for $199 when available and clinically appropriate.

Membership is not insurance and does not replace health insurance. When appropriate and covered, MDHC may bill Medicare, commercial insurance, or other payers for medical services provided.