MEMBERSHIP

* A membership fee of $125 per month is charged to the member’s credit card at the start of each month.

* A member may cancel at any time after the first 3-month initiation. Any charges to your card after the first of the month following cancellation will be refunded in full.

* Services included in membership: same or next-day clinic acute visits, wellness visits, check-up visits, physical exams, risk assessment, phone consultations, EKGs, email consultations, prescription renewals, referrals, test ordering, coordination of care, maintenance of your medical record, and more – all at no additional charge.

Siuslaw Medical Clinic

1845 Highway 126

Florence OR 97439-9626

(541) 999-6599

egar@siuslawmedical.com

ORS 836-200-0315: The Department of Consumer and Business Services has issued a certification to this practice. You can contact consumer advocates at the Department of Consumer and Business Services at (888) 977-4894

 dcbs.insmall@state.or.us, or www.insurance.oregon.gov.

Membership application

Please fill out the form below to apply for membership. This process is merely a basic request to join the Siuslaw Medical Clinic. We do not ask for any confidential details about your health at this time. The information we collect on this form is not shared and will be strictly used for our records only.