Dr. Calegari's Registration Form

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Please read: You are registering under Dr. Calegari's Primary Care Panel, starting July 22nd, 2024, at Delphi. The access fee ($120 / month or $1,200 / year) you pay serves not only as a membership but also grants you a personalized healthcare experience with your doctor. By having a limited panel, your doctor can devote more time and attention to your health needs and goals, ensuring increased access, quality, coordination, and affordability for your Primary Care needs.

You will receive a welcome packet with further information regarding DEPC.

Once we have registered your account you will receive an invoice for payment.

If you plan to have a spouse or dependent added to your membership, please have them fill out a separate registration form.

First Name *

Last Name *

Date of Birth - Must be 18 or older

YYYY

Please Pick a Membership Option *

$120 / Month

$1,200 / Annual

Will You be Adding a Spouse or Dependent? *

Yes

If Yes to Spouse or Dependent Please Provide Their First and Last Name *

Email Address *

Cell Phone Number *

Street Address *

City *

State *

Zip Code *

Insurance Carrier *

How did you hear about us?

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