STOP!
READ this before you click
-
If paying by cash or check stop by our office don't fill out this form
-
Check Out our Patient Agreement
-
Have the Date of Birth for all applicants
-
If paying by Credit/Debit card have card info
-
If paying by ACH autopay have banking account info
-
If you have any questions CALL: 305-851-8903​
-
Be aware that you will not be instantly charged, we will confirm your membership manually to make sure you are being charged the correct amount
-
If you finish and believe you may have made a mistake on the sign up form please send an EMAIL to: Admin@1to1patientcare.com
WELCOME
Stop by and say Hello! After joining online you will need to stop by and sign your agreement, a Medicare form if over 65, and a form for releasing your health records. We can also email these documents to you if you would like, and you can print, sign and send them back. Shelly will review your records and set up an initial appointment with you. You should not hesitate to call our office number with any health questions or concerns you may have. Please if it is an emergency dial 911 or go directly to the emergency room.