Pre-Enrollment Form

Concierge Direct Care

PRE-ENROLLMENT FORM

We are honored that you have considered Lotus MD as your healthcare home & are most excited to welcome you to our Practice.

While we are still in the development stages, you are most welcome to submit your information so that we may contact you as soon Lotus MD opens its doors.

Please note:
​​​​​​​At this time, we are not able to accept individuals who are enrolled in Medicare (due to CMS/Medicare Rules & Regulations.) We anticipate opening our Practice to Medicare beneficiaries in the coming months.

We highly appreciate your interest & understanding – Thank you!

Are you a Resident of:

Consent to Contact via Email, Phone Number, Text Messages and/or FaceTime/Virtual Platform:

Please note:
We will never intentionally give or sell this information to any third party to gain profit or leverage without your consent.