DirectcareMD

DCMD enrollment is simple!

To enroll in DirectcareMD is really very simple. Download the Household Agency Agreement, the credit card payment authorization form, and the member emrollment roster. After you carefully read and complete the forms, you may mail or fax them to:

DirectcareMD PO Box 89 Chehalis, WA 98532

Fax: 360-740-0555

Household Agency Agreement - (pdf file) The Household Agency Agreement is the agreement between DirectcareMD, the participating physicians and your household.

DCMD Member Enrollment Form - (pdf file) All uninsured members of a household must be enrolled. Please be sure to enter birthdates, and check which program you would like. DCMD can be especially advantageous for those who carry high deductible insurance.

DCMD Member Enrollment Form - Children Only - (pdf form)

Credit Card Payment Authorization Form - (pdf file) Payments are accepted only through a pre-authorized, recurring charge to a single credit card. The recurring monthly fee will be processed after the month of service.


		DCMD enrollment is simple! To enroll in DirectcareMD is really very simple. Download the Household Agency Agreement, the credit card payment authorization form, and the member emrollment roster. After you carefully read and complete the forms, you may mail or fax them to: DirectcareMD PO Box 89 Chehalis, WA 98532 Fax: 360-740-0555 Household Agency Agreement - (pdf file) The Household Agency Agreement is the agreement between DirectcareMD, the participating physicians and your household. DCMD Member Enrollment Form - (pdf file) All uninsured members of a household must be enrolled. Please be sure to enter birthdates, and check which program you would like. DCMD can be especially advantageous for those who carry high deductible insurance. DCMD Member Enrollment Form - Children Only - (pdf form) Credit Card Payment Authorization Form - (pdf file) Payments are accepted only through a pre-authorized, recurring charge to a single credit card. The recurring monthly fee will be processed after the month of service.