DPC Registration

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DPC Registration

Signing Up for Direct Primary Care is Simple!

To sign up, select the type of Direct Primary Care membership you would like, then input the requested information and click the green “Submit” button.

A Teton Valley Health representative will then prepare the documents required to finalize your registration. These documents will be sent to the email address provided within a few business hours. From the email you will be able to review, complete, and electronically sign all necessary documents. Once you electronically sign, your registration is official!

Non-Profit Membership Rates Available

As an added benefit and thank you to our local non-profit organizations, if you are employed by a non-profit and wish to subscribe to Direct Primary Care, you will receive a discount on your monthly membership rate. Details can be found on the Patient Agreement Form.

If you would like to review the documents before the email arrives, the links to each document are located at the bottom of this page. If you have any questions, call 208.354.6324.

Sign-up for Direct Primary Care Today!

Type of Membership(Required)

How many family members?(Required)

Includes up to 2 adults and all minor children in the same household.

Please enter the name and birthdate of the individual in the fields below.

Name(Required)

First Last

Birthdate(Required)

Which payment plan to you choose?(Required)

Name (Financially Responsible Party)(Required)

First Last

Email Address (Financially Responsible Party)(Required)

Phone number (Financially Responsible Party)(Required)

Please enter the names and birthdates of family members in the fields below.

Name 1(Required)

First Last

Birthdate 1(Required)

Name 2(Required)

First Last

Birthdate 2(Required)

Name 3(Required)

First Last

Birthdate 3(Required)

Name 4(Required)

First Last

Birthdate 4(Required)

Name 5(Required)

First Last

Birthdate 5(Required)

Name 6(Required)

First Last

Birthdate 6(Required)

Name 7(Required)

First Last

Birthdate 7(Required)

Name 8(Required)

First Last

Birthdate 8(Required)

Name 9(Required)

First Last

Birthdate 9(Required)

Name 10(Required)

First Last

Birthdate 10(Required)

Name 11(Required)

First Last

Birthdate 11(Required)

Name 12(Required)

First Last

Birthdate 12(Required)

Name 13(Required)

First Last

Birthdate 13(Required)

Name 14(Required)

First Last

Birthdate 14(Required)

Name 15(Required)

First Last

Birthdate 15(Required)

Name 16(Required)

First Last

Birthdate 16(Required)

Name 17(Required)

First Last

Birthdate 17(Required)

Name 18(Required)

First Last

Birthdate 18(Required)

Name 19(Required)

First Last

Birthdate 19(Required)

Name 20(Required)

First Last

Birthdate 20(Required)

Which payment plan do you choose?(Required)

Name (Financially Responsible Party)(Required)

First Last

Email Address (Financially Responsible Party)(Required)

Phone number (Financially Responsible Party)(Required)

Optional Comments or Questions

Below are links to the documents required for Direct Primary Care membership registration. These are provided for your convenience if you wish to review them prior to receiving your registration email. Please contact 208.354.6324 with any questions. To register, fill out the web form above and a Teton Valley Health representative will prepare and email you the needed documents to electronically review, complete, and sign.