Annual Membership - Sign Up

We appreciate that you have chosen MedPlus Immediate Care for your medical needs. We accept cash, debit/credit cards, and ACH auto draft. Payers by cash must pay the full amount in person. Debit card, credit card, and ACH auto draft users may make 3 easy monthly installments of $133.33; however a 3% convenience fee will be added to all debit/credit card transactions. Please complete the questions, and you will be forwarded the enrollment agreement sent in DocuSign. You will simply sign the agreement and provide your credit card/debit card or bank information. Your start date will be the date on which your payment is made.

Name(Required)
Date of Birth(Required)
Address(Required)
Which clinic you will be using:(Required)
Please indicate preferred payment method(Required)