ENROLLMENT FORM

 

Dr. Neu is NOT accepting new members at this time. Jessica Love (family nurse practitioner) is pre-enrolling patients with service to start Jan. 1, 2018. Please contact us with any questions about this. 

Please complete a profile for EACH INDIVIDUAL (adult or child) to be included on your account. 

If you are not part of an employer-sponsored plan, there is a $80 enrollment fee (per household) and the initial month's membership fee(s) (pro-rated based on start date) before first visit or service begins. Credit card entered here not charged until membership finalized. 

Auto-payment with credit/debit card on preferred day of month is required for payment of future fees. Full payment policies here