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Membership Requirements

  1. Completion of enrollment forms including a contract, billing authorization, patient history, and release of information.
  2. No enrollment fee
  3. Ongoing monthly membership fee

Fill-out Membership Form

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If you prefer to fill out your forms and bring them into the office, click below:

Freedom PC DPC contract

Enrollment and Billing Authorization Form

Authorization to Release Healthcare Information

Patient History

Submit your Infomation and Forms

Important Information to Know

  • Enter First Name *
  • Enter Last Name *
  • Enter Email Address *
  • Enter Phone Number *
  • This field is for validation purposes and should be left unchanged.
  • We do not accept insurance.
  • This is not an insurance plan.
  • We recommend you carry catastrophic insurance in case you have an accident or major injury requiring hospital care.
  • Medicare-eligible patients will need to sign a form indicating they understand that their Medicare benefits will not be used for Primary Care.
  • Our members have nearly 2/47 access to our practitioners via phone, email, and text, including after-hours appointments.
  • Members may cancel their membership at any time.
  • Members may need to seek urgent care or emergency room care from time to time at their own expense, or using their insurance.
  • We do not offer vaccinations.