Renew Your Membership

Physicians - Please fill out the form below and download the Membership Application to successfully renew your membership with Docs 4 Patient Care.
(Note: Be sure to only click the 'Submit' button once.)

Medical Students/Residents - Please click here to renew.

Personal Information

First Name *

Last Name *

Email Address *

Billing Address *

City *

State *

Zipcode/Postcode *

Country *

Employer *

Specialty *

Billing Information

Name on Card *

Card Number *

Card Expiration *

Card Type *

CCV Number *

Membership Information

*Please Select your Membership Level:

Gold and Active membership relate to the support levels of membership. In order to maximize our influence and meet our society objectives, we hope for your gold membership today.

Gold $1000
Active $250

Total Amount *
$

Please review this amount before submitting to verify that it reflects the Membership Level & optional Contribution Amount you've requested. You may change this amount by checking & unchecking the appropriate boxes.

To complete your payment, click 'Submit' ONLY ONCE. Your transaction may take a few seconds, so please be patient. Clicking 'Submit' will process the above total based on the payment and billing information provided. Thank you.

Please Note:
Membership Disclaimer:
Docs 4 Patient Care is a 501(c)(6) corporation. Docs 4 Patient Care physician membership dues are not deductible as a charitable contribution for federal income tax purposes. However, they may be partially deductible as a business expense. Please consult your professional tax advisor for the most up-to-date information concerning your specific tax status. Contributions by non-members are not tax deductible except by certain criteria, which should also be discussed with your professional tax advisor.