Core+ Membership

First Name of Member *

Last Name of Member *

Phone Number of Member *

Email of Member *

Full Name of Payor (if different than member name)

By checking this box, I consent to receive marketing non-marketing text messages from AMS Lifestyle and related companies. I understand that text messaging is not HIPAA compliant and will use the patient portal for care. Message frequency varies, message & data rates may apply. Reply STOP to opt out but please check your email as we will not be able to text you if you text STOP.