Please complete this request to join and we will send you patient intake forms via our Electronic Health Records system to complete your membership activation and get your medical kit on its way to you!
**Membership is $20.00/mo for one child or $25.00/mo for more than one child (from the same family) and a one-time registration fee per family of $126 (+ tax and shipping) which includes your medical kit with a digital otoscope for examining the ears, a digital thermometer, and a pulse oximeter.
Email us at pediatricsoncall247@gmail.com with any questions!
NOTE: Once you complete this form, please follow the instructions on the next page. There is another short form to be filled out.

