Medplus Membership The MedPlus Annual Membership program is a medical clinic membership designed to help those who are underinsured or not insured at all. The monthly installment plan offered here is available exclusively on line. Membership applicants who have been treated at any of our clinic sites in the last year are not eligible to participate in this promotional online offer as they are considered to already be established with the clinic. Those that are established have an alternative membership that can only be signed up for in person in one of our clinics. For more information about our membership program available for established patients email us at info@medplusimmediatecare.comMedplus Immediate care agrees to provide unlimited visits to all members for a $100 enrollment fee and $39 a month for 11 months. All visits include a review of the medical history, medical examination, diagnosis, and any services listed below that are deemed necessary by the attending medical provider at the time of each visit. Services not listed below in the “services included” will be the responsibility of the member. Additionally, outpatient treatment or inpatient treatment at other medical facilities is not included with the MedPlus Annual Membership Program. MedPlus Immediate Care has clinics in Macon, Milledgeville, Eastman and Dublin. Accordingly, all members will have full access to all 4 clinics. For more information about out clinics and their locations visit out website at medplusimmediatecare.com. The Membership automatically renews on the anniversary day of the initial enrollment however no reenrollment fee will be charged. The standard monthly fee will continue after the first year and any change to the standard fee by MedPlus Immediate Care, LLC must be preceded by a 90 day advance notice by MedPlus Immediate Care, LLC and shall not apply to members until the next anniversary date. (standard monthly fee is defined as the fee that is charged to members. A change in the standard monthly will not apply to existing members until renewal on their anniversary date) Members may terminate the membership at any time however, immediate termination before the anniversary date will result in converting all services we have provided in the current membership year to our cash price. Members may terminate their membership in writing at least 90 days before the anniversary date and can avoid conversion of all the services they received for the current membership to the cash price by paying the monthly fee until the anniversary date. Conceivably, early termination where a good number of visits occurred could cause an immediate balance at the termination date that exceeds the aggregate balance for the current membership year. You may be terminated with 30 days notice for acts of fraud, failure to adhere to a recommended treatment plan, or if you act in an abusive manner that presents an emotional or physical danger to the staff or other patients in the practice. The MedPlus membership agreement is not transferable.SERVICES INCLUDED:Physical examinations Telemedicine visits (must have an initial visit in house on record to do a telemedicine visit) Workers comp visits (if membership paid by employer) Diagnosis Treatment in house x-rays Urinalysis urine pregnancy test urine drug screen complete blood count comprehensive metabolic panel hemoglobin A1c amylase lipase testosterone level thyroid panel PSA urine culture lipid panel basic metabolic panel finger stick glucose EKG holter monitor Rocephin injection Phenergan injection Zofran injection Toradol injection Benadryl injection I and D abscess simple laceration repair simple removal foreign body ear wax removal steroid joint injection ingrown toenail excision trigger point steroid injection intravenous fluids (IV fluids) SUPPLIES AND TESTS THAT ARE PROVIDED AT COST Orthopedic splints, braces, crutches and other DME $15-$30 Rapid flu/covid combo $15 Rapid strep test $15 Rapid Mono $15 Rapid RSV $15The member agrees to participate in ACH autodraft of the monthly Standard fee which is currently $39 per month for 11 months with a sign-up fee for the first month of $100. The member agrees to notice MedPlus Immediate Care, LLC before 90 days of the anniversary date of any intention to end the membership agreement on the anniversary date with the understanding the agreement renews on the anniversary date if no such notice from the member occurs. FOR ADMINISTRATIVE USE ONLYPrinted name authorized representative MedPlus Immediate CareAuthorized representative MedPlus Immediate CareDatePrinted Member Name(Required) First Last Member Phone(Required)Email(Required) Current Date(Required) MM slash DD slash YYYY Birth Date(Required) MM slash DD slash YYYY Do you have a Referral Code provided by one of our representatives?(Required) Yes No Please provide the Referral Code if you were given one by one of our representatives:(Required)Please indicate how you learned about our program:(Required)FacebookInstagramOnline SearchFriend or FamilyEmployerOtherACH Authorization Form MedPlus Immediate CareCorporate Offices102 Corporate SquareDublin, Georgia. 31021I (we) hereby authorize Medplus Immediate Care(THE COMPANY) to initiate entries to my (our) checking/savings accounts at the financial institution listed below (THE FINANCIAL INSTITUTION), and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until THE COMPANY is notified by me (us) in writing to cancel it in such time as to afford THE COMPANY and THE FINANCIAL INSTITUTION a reasonable opportunity to act on it.Name of Financial Institution(Required)Address of Financial Institution(Required)Name(Required)Address(Required)Date(Required) MM slash DD slash YYYY Payment Amount: $100 one timePayment Amount: $39 monthly for 11 monthsFinancial Institution Routing Number(Required)Checking/Savings Account Number(Required)
