Patient Enrollment Form for Select Internal Medicine in Frisco, TX

Choosing concierge medicine offers various benefits you don’t have access to with traditional medical models.

Patient Information

This information will be sent to your provider and will be kept as part of your patient records. Membership fees: Individual $3,000 and Couples $5,000. This fee can be paid annually, biannually or quarterly. This fee is not covered by insurance. Our annual membership fee covers concierge practice benefits. We accept most insurances for medical visits, labs, and diagnostic testing (if applicable).