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Member Registration

Step 1: Enter Member Details

Step 2: Select a Plan

Step 3: Enroll

Step 1: Enter Member Details

Member Details:

First Name*

Last Name*

Date of Birth*

Age*

Gender
Male Female

Salutation*

Email*

Mobile Number*
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Country*

State*

City*

ZIP / Postal Code*
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5-digit ZIP 4-digit ZIP

Login Credentials:

UserName*

Confirm Username*

Password*

Confirm Password*

Enable 2-factor authentication :

Do you want to Enroll Plan

Step 2: Select a Plan

Search Plans by Facility Name or Provider Name:

Facility Name

OR

Provider Name

Plan Name

Change search

Select a plan:

Select a payment schedule:

Plan start date *

Step 3: Enroll

Selected plan:

Plan Name

Plan Type

Plan Duration

Enrollment Fee

Plan Amount

Plan Start date

Plan End Date

Visit Fee

Installment Amount

Installment Fee

Payment Schedule

Terms (No. of payments)

Plan Decription

Pay Now:

Please enter Card Details :

Amount *

Card Number*

Name On Card*

Expiry Date (MM/YY)*

CVV*

I Accept the Terms & Conditions for Member