Congratulations. Your medical provider has prescribed a program to help improve your quality of life and healthcare outcome.

Your provider wants you to complete the form below to activate your prescription and confirm your enrollment in this important service.

Remote Services Enrollment Registration Form
Your healthcare provider has prescribed a program that Medicare designed to improve outcomes for members with chronic conditions.
This question is to ensure you are still eligible for this program.
You do not have to have Medicaid to be eligible for this program.
You might have a small co-pay if you do not have full Medicaid coverage. However, if you have supplemental insurance, it will likely cover the cost of this small copay. Our goal is to provide a service that improves your health and reduces what you pay to stay healthy. We hope you will find value in the Remote services. However, you can stop the Remote services at any time.