Enrollment

Now Enrolling New Patients!

 

If you are interested in becoming a member of our practice please feel free to read the patient agreement form and enroll online. Please read, sign and send us your completed new patient forms which are available below for download to complete the enrollment process. Forms can be returned via email to help@affirmhd.com or by fax to 740-777-9041. We will contact you once we receive all of your enrollment information. We look forward to meeting with you and caring for you.

Monthly Membership Fee

Children (0-18)
$20 with adult member
Children (0-18)
$50 without an adult member
Adults (19-64)
$70
Adults (65+)
$85

Enrollment Fee

One time Enrollment fee equal to one month’s membership is due upon enrollment.

 

Business Plans Available

Call office for more information.

*Enrollment fee is non-refundable.

*enrollment fee and monthly membership discounts are available for large families i.e. > 4 enrolled family members. Please call our office for more information.

*Persons covered under a Medicare type plan are unable to  join our practice at this time per Medicare rules.

*Be aware that Dr. Wion does not routinely prescribe controlled medication for chronic use but is more than happy to facilitate referrals to specialist who treat the underlying conditions and who might opt to prescribe these medications chronically.