Loudoun Holistic Concierge Medicine Membership Application Form

Loudoun Holistic Health Partners is accepting membership renewal applications from current LHHP Concierge Members until September 15, 2017. Membership applications will be reviewed and accepted on a first-come first-serve basis.

Current LHHP Concierge members are encouraged to submit their membership application request as soon as possible to avoid being placed on a waiting list, as membership openings are limited.

If membership openings remain available after September 15, 2017, membership will be opened to the general public and applications will be reviewed and accepted on a first-come, first-serve basis until we reach our membership quota for the 2017-18 membership period.

Please complete the form below to request an application for membership in the Loudoun Holistic Concierge Medicine Program for the 2017-2018 membership period. We will email you your 2017-2018 membership enrollment and registration documents once we receive your completed application. A $1,000 nonrefundable application fee is required to reserve each member’s spot in their Membership Category. Your membership is not reserved until the $1,000 deposit has been paid.
 

LHHP Concierge Medicine Membership Application Form

New Member Application
Visit this link to view and download the Membership Information Packet with full details on Membership Categories and associated fees: http://loudounholistichealthpartners.com/wp-content/uploads/2017/08/lhhp-member-info-packet-8-04-2017.pdf
If you have comments, questions, or additional information that you want to share with us about the applicant(s), please enter your comments/questions/additional information here. We will reply as soon as possible.
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