ENROLL NOW!

Just 3 Easy Steps to Savings! It's easy.

1. Please enroll me and my family TODAY in Discount Medical.

My Information
 Gender
Name
Spouse Information
 Gender
Name
Dependent's Name
 Age Gender
1.
2.
3.
4.

2. CHOOSE YOUR PLAN

Description Retail
Price		 Your
Price
Individual Medical Plan - Monthly
$24.95
$16.95
Family Medical Plan - Monthly
$29.95
$19.95
Individual Medical Plan - Annual

$199.00
$159.00
Family Medical Plan -Annual

$249.00
$199.00
 
*All plans are plus $20.00 non-refundable processing fee.
Effective Date: First of the Next Month

3. AUTOMATIC MEMBERSHIP RENEWAL

Check here to authorize the automatic renewal of my membership upon expiration and ensure uninterrupted Discount Medical savings.

30-Day Risk-Free Money-Back Guarantee:
If you are not completely satisfied within the first 30 days, simply call and return your membership ID card for a complete refund. ($20.00 processing fee not included)

Additional Terms and Conditions:
By submitting this form I understand that this agreement will remain in effect until Discount Medical has received a written notice and my membership card from me indicating it should be cancelled. Written notice of cancellation must be received at least 3 business days prior to the date of my next scheduled payment to insure prompt processing of my cancellation without further withdrawal from my account.
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SAVE UP TO 50% ON PRESCRIPTION EYEGLASSES & CONTACTS
SAVE UP TO 30% ON PHYSICIAN'S FEES