CORONAVIRUS UPDATE: Please click here for coronavirus updates from the Centers for Disease Control (CDC):

As a precautionary measure we are asking any member seeking an appointment for any respiratory issues to first call the clinic at 208.900.9500 or contact us via your secure patient portal to make a phone appointment with one of our providers. For the time being we are not accepting any walk-in patients with respiratory symptoms (cough, shortness of breath, fever). Instead, we are first scheduling phone appointments with those that have these symptoms before scheduling in-clinic appointments. Our goal is to keep you safe and to take precautions from exposing our staff and medical team to COVID-19. Thank you in advance for following these instructions and for staying calm during these uncertain times. We are here to help!

Clinic Space is Limited – Join Today!

Enrolling in Appleton Clinics is quick and easy using this secure form

  • If you prefer, call (208) 900-9600 to speak with an enrollment specialist and enroll over the phone or in person.
  • Each adult membership is $99 per month, collected automatically from your credit or debit card.
  • If you choose to pre-pay annually, you will receive two months free (total = $990 per adult).
  • Adult members may add up to two children under 26 free per family. Additional children are only $10 per month each.
  • A one-time $99 registration fee per adult will be included in your total initial charges.
  • You may cancel at any time. No refunds are allowed.

We do not deny membership for pre-existing conditions or lack of insurance coverage.  Clinic space is limited.  Once you submit this application and complete your medical history form(s) we will contact you if we have any questions or concerns about our physician's ability to properly care for you given your particular healthcare needs and our current patient capacity.  If for any reason your membership is not accepted, we will refund your $99 enrollment fee(s).

Basic Contact Information

Home Address

Contact Information

Emergency Contact

Set Username and Password for Patient Portal

To gain online access to your medical records and secure communications, please create a username and password that you will use to log into the patient portal in the future.

  • Your username must be at least 4 characters long.
  • Each participating member on your account must have a unique username and password.

Your password must be at least 8 characters long and include at least one number or special character.


Credit/Debit card monthly auto-payment required for membership fees.

PLEASE CHOOSE your preferred billing frequency.

Card Details


Card Billing Address

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On behalf of all of the members on this account, I understand and agree to the following (read and check all items indicating your acceptance):

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