Virtual Membership

Enroll in the Virtual Primary Care Visit Membership

Complete this secure form to start your virtual membership. You’ll be redirected to Stripe’s secure checkout page to enter your payment details.

Patient Information

First Name *

Last Name *

Date of Birth *

Mobile Phone *

Email Address (for receipts & portal access) *

State where you will receive virtual visits *

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 consent to receive care via telehealth and confirm I will be located in a state where MDHC providers are licensed at the time of each visit.

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.