Individual Membership Plan - Peak Family Health PLLC

Individual Membership

Affordable and Flexible Healthcare

$160/month for 1 person + $50 one-time registration fee

Terms:

1 Month for $210 then $160 / Month

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Phone Number:* Phone Number is Required

Birthdate:* Birthdate is Required

Driver's License:* Driver's License is Required

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

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Terms: 1 Month for $210 then $160 / Month

Description	Amount
Individual Membership Plan – Initial Payment	$210.00
Total	$210.00

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