Care Membership Enrollment
Select your membership plan. Review plan details, pricing, and terms on our website. For questions, contact amanda@novushealthstl.org. Memberships do not cover hospitalization, ER, urgent care, or full medication costs.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Are you a new patient?
*
Yes
No
MEMBERSHIP OPTIONS
*
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( X )
Essential Care: $100 per Month
$100.00
$
100.00
for each
month
Essential Care Plus: $250 per month
$250.00
$
250.00
for each
month
PrEP Care (Monthly): $25 per Month
$25.00
$
25.00
for each
month
PrEP Care (Yearly): $270 per Year - a 10% savings
$270.00
$
270.00
for each
year
Credit Card
Subscription & Automatic Payment Authorization
Your membership subscription payment will be automatically processed on the 1st of each month using your selected payment method.If your payment is declined or cannot be processed, a NOVUS staff member will contact you to arrange an alternative payment method to help keep your membership active.
I consent to the NOVUS Health Care Membership Terms and understand that membership does not cover hospitalization, emergency room, urgent care visits, or full medication costs.
I consent to the membership terms.
Any additional information you would like us to know:
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