Medical Membership Enrollment

Medical Membership Enrollment
Primary Member*

First NameMiddle InitialLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Phone Number*
Format: (000) 000-0000.
How many individual's would you like to enroll for medical membership Please fill out the fields below. We will need there name and date of birth for additional members
Male Female New Member
Membership Fees

$59.99/month/person
Please contact Jennifer at (448) 444-4325 ext 114 to process your 1st month payment for the Medical Membership and to complete your application.

A member may cancel their ProHealth Medical Membership (PMM) by emailing customerservice@prohealthfl.com at least 30 days prior to their monthly renewal date. Notices must be received before the end of business hours on the 30-day notice date in order to terminate for the following month. The member is responsible for payment of all fees, dues, and charges owed to ProHealth. Membership fees will not be prorated. Membership fees will not be prorated for partial months. If cancellation occurs before completing the initial six-month term, a $25 cancellation fee will apply plus the balance of the remaining membership commitment.
Type a question
Should be Empty:

Membership Fees