Purchase an Annual Subscription $199.00

  • Please enter first and last name of the new member.

    New Member Name

  • What is the new member’s address?

  • Please enter the new member’s date of birth.

    Member Date of Birth

  • Date Format: MM slash DD slash YYYY
  • Please indicate the new member’s biological sex as defined for medical decision making.

    New Member Sex

  • Please enter the email address that should be used for communications with the new member.

    New Member Email

  • Please enter the new member’s mobile and secondary phone numbers.

    New Member Mobile Phone Number

  • New Member Secondary Phone Number

  • Please enter the email address associated with the form of payment you will be using to purchase this membership. Receipts for the initial purchase and any subsequent renewals will be sent to this address.

    Billing Email

  • Terms of Membership

    Ascend Patient Membership Agreement

  • Click here to view Membership Agreement