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MEMBER ENROLLMENT

Joining Eagle Medical Center is easy. Just fill out the form below and someone from our office will contact you. We will never share your private information. Be advised: Eagle Medical Center does not accept insurance of any kind. If you have more questions about the direct primary care model or enrollment, please contact us. This form will take approximately 10-15 minutes to complete and will require information about your medical history. Payment will not be due until your enrollment is final. For your convenience, click to access our patient agreement, records request formprocedure consent form, and credit card authorization form.

If you're on a mobile device, please click here to complete your enrollment.