First Name *

Last Name *

Email *

Phone *

Adults (18-64) *

Seniors (65+) *

Students (Full-time Undergraduate College or Technical School) *

Children (2-17) *

Infants (1-24months) *

Children and infants cannot join independently and must be included as part of a Family Membership Plan with an adult or senior.

Preferred Membership Start Date *

Today

1st of Next Month

Have you ever been a patient of Christian Healthcare Centers? *

Yes

What brings you back to Christian Healthcare Centers? *

Are you a Samaritan member? *

Yes

I authorize Christian Healthcare Centers to send email or text which may include unencrypted protected health information.

Providing us with authorization to email and text you will allow Christian Healthcare Centers to exchange information with you more efficiently and will benefit you as a member. At the same time, we recognize that email and text messaging are not a completely secure means of communication.

You are not required to authorize the use of email and text messages and a decision to not authorize electronic communication will not affect your health care in any way.

We have taken considerable effort to protect the personal health information of our members, and recommend that all members provide us with this authorization so that we can more efficiently communicate with them.