Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Join DiscoverU Health We're thrilled by your enthusiasm to join DiscoverU Health as a valued member of our exclusive concierge medical services. Your Name *Email *LayoutDate Of Birth *Your Age *Phone Number *NextLocations Adding your location will help us find the nearest health services provider near you. Address *Address Line 1Address Line 2CitySelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you have insurance? We're thrilled by your enthusiasm to join DiscoverU Health as a valued member of our exclusive concierge medical services. Select from below *Yes, I have insuranceNo, I don't have insuranceOtherNo worries. DiscoverU Health provide several membership options for uninsured individuals.Select Insurance *MedicaidCommercial OnlyMedicare 65+ OnlySelect Commercial Insurance *CarefirstUnited HealthcareAetnaPlease enter the name of your insurance providerJoin DiscoverU Cares We are excited to deliver optimized and relevant health experiences to you! Your well-being is our priority, and this information will help us tailor our services to your specific needs. Emergency Contact Name *Emergency Contact Phone Number *Locations Adding your location will help us find the nearest health services provider near you. Address *Address Line 1Address Line 2CitySelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you have insurance? We're thrilled by your enthusiasm to join DiscoverU Health as a valued member of our exclusive concierge medical services. Select from below *Yes, I have insuranceNo, I don't have insuranceOtherNo worries. DiscoverU Health provide several membership options for uninsured individuals.Select InsuranceMedicaidCommercial OnlyMedicare 65+ OnlySelect Commercial Insurance *CarefirstUnited HealthcareAetnaPlease enter the name of your insurance providerYour Health Preferences Providing the following information can help us tailor membership services to your health needs. Are you interested in virtual or home-based care?Virtual CareHome-based CareWhat are your health concerns?PreviousNextYour Membership Plan The following membership plan has been selected based on the information provided. Layout Concierge Bronze+ $297/year | $24.75 /month Your membership benefits include: Telehealth Services Concierge Home Visits Same / Next Day Appointments 24/7 Chat via Portal Concierge Gold+ $1,188/year | $99.00/month Your membership benefits include: Telehealth Services Concierge Home Visits Same / Next Day Appointments 24/7 Chat via Portal Concierge Silver+ $597/year | $49.75 /month Your membership benefits include: Telehealth Services Concierge Home Visits Same / Next Day Appointments 24/7 Chat via Portal Select Membership Plan *Concierge Bronze+Select Membership Plan *Concierge Gold+Select Membership Plan *Concierge Silver+Add Services Concierge Platinum+ $597/ yearAdd ServicesConcierge Platinum+ $49.75 / monthSelect Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlySelect Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlySelect Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlyPayment Summary$ 0.00Your Membership Plan: The following membership plan has been selected based on the information provided. LayoutSelect Membership Plan *Concierge Bronze | $948 / year | $79 / month (Virtual Care Only)Concierge Silver | $1,788 / year | $149 / month (Preventative Care Only)Concierge Gold | $2,388 / year | $199 / month (Comprehensive Care Only)Concierge Platinum | $3,588 / year | $299 / month (Full Coverage)Select Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlySelect Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlySelect Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlySelect Billing Period *Yearly (5% Off)Yearly (5% Off)MonthlyPayment Summary$ 0.00LayoutView Membership Plan: The following membership plan has been selected based on the information provided. Concierge Gold+ $1,188/year | $99/month Your membership benefits include: Telehealth Services Concierge Home Visits Same / Next Day Appointments 24/7 Chat via Portal Learn More Add servicesConcierge Platinum+ $597/ yearAdd servicesConcierge Platinum+ $49.75/ monthDo you need Home Care?YesNoSelect Billing Period *Yearly (5% Off)MonthlyPayment Summary$ 0.00In-person Home Care Assessment: Thank you for providing your information. We will use it to tailor our services to your specific needs. Let’s go ahead and schedule an in-person client assessment of your health concerns and environment. This will allow us to determine and tailor a custom home care plan suitable for you. Stripe Credit Card *PreviousSubmit