At-Home Membership

Enroll in the At-Home Primary Care Visit Membership

Complete this secure form to start your membership. You’ll 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) *

Address Line 1 *

Address Line 2

City *

State *

ZIP Code *

Billing Preference *

Reason for joining / key concerns (optional)

I have reviewed and agree to the Membership Subscriber Agreement.

I acknowledge receipt of the HIPAA Notice of Privacy Practices.

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

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.

$249 / month

Or $2,700 / year (prepaid) – select during enrollment.

Membership is not insurance and does not replace health insurance. Certain services may be billed separately or to your insurance when appropriate.