Apply to be a DPCA Member

Submit this form with your details

You will be added to our pending member database. We will review your application.

Once approved, you will get a confirmation email with a link to create your account. Your account will be valid for a year.

You will be directed to a payment portal. Enter your details and submit. You will not be charged yet.

We will review your application

Once approved you will get a confirmation email with a link to create your account. Please ensure the email you enter here is correct.

After a 10 day free trial, your payment will be transferred

$200 Billed Monthly

First Name*

Last Name*

Address Line 1*

Address Line 2

City*

State*

Zip*

How did you hear about us?*

NPI Number*

Medical School*

Medical School Grad Year*

DPC Website*

DPC Practice Name*

Specialty

Email*

I understand the membership fee will be renewed automatically.

Thank you! Your submission has been received!

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