Priority Membership Activation & Waitlist
Secure your custom rate for our August launch. Fill out this 2-minute form to claim your spot on the founding member waitlist.
Name
*
First Name
Last Name
Please Select Your Age Bracket
*
14 to 18
18 to 25
26 to 40
41 to 65
66 and above
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Were you actively established as a clinical medical patient of Dr. Sri within the last 3 years at either the UK Health Georgetown Clinic or the GT College Training Room? (Note: You must be prepared to present your past EMR/medical records upon request to verify patient status. Friends, colleagues, or non-patient encounters do not qualify).
*
Yes, I was Dr.Sri's Patient
No
Are you currently a college student?
*
Yes
No
Please enter your college/university email address for verification:
Eg.,(name@uky.edu)
Calculated Enrollment Fee
Calculated Membership Rate
Submit (Email arriving in 60s)
Should be Empty: