Please fill out the form below to sign up as my direct primary care patient! If you’d like, please review the Frequently Asked Questions page, the Plans Overview page, or contact me with questions! Or, if you’re ready for a direct primary care subscription, just sign up below! Subscribe to become a patient Thank you for considering me as your direct primary care physician! Whether you've been my existing patient or whether you'll be a brand new patient, please start the process by filling out the form below! Step 1 of 2 50% Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Click the "Next" button below to choose your subscription plan and find out the next steps. For which plan would you like to sign up?*Plan A, for those age 15-39Plan B, for those age 40-64Plan C, for those age 65+How did you hear about me?*I'm an existing patientWord of mouthFrom a friendWeb searchOtherAfter submitting this form, I will call you very soon and we'll schedule your first appointment. During that first appointment, we'll take some time and discuss your medical records and my role as your direct primary care physician. I look forward to being your doctor!