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Membership

MONTHLY FEES:
Adults over age 21: $105
Ages 12-21: $70

A one-time, non-refundable registration fee of $100 applies (with a maximum of $250 per family). Memberships can be canceled at any time; however, if you choose to re-enroll, a new registration fee of $150 will apply.

Monthly fees will be automatically drafted.

Please note that patients under 12 will be seen only for acute issues on a case-by-case basis. Primary care and wellness services are not provided for children under 12.

Name

First Last

Phone

DOB

Insurance Type (If any)

List any chronic health conditions you have.

List any current medications you are taking.

Are you a previous patient of Dr. O'Neal?

Yes