ENROLLMENT FORM



Please complete a profile for each individual—adult or child—to be included on your family’s billing account. 

NEXT STEPS: There are a few forms you will need to complete to finalize your membership, including a health history. Please follow instructions at the end of this enrollment to complete those.

INITIAL & AUTO-PAYMENTS: If not part of an employer-sponsored benefit….. There is a $80 enrollment fee per household. Payment of this fee plus the initial month's membership fee(s) is required before your first visit(s) or start of service. Future payments will be made by auto-payment on your preferred day of month with a credit/debit card or bank account on file with us—we will send you an email to collect that payment information or you can provide it in-person. Full payment policies here.