VIP PROGRAM FOR THE UNINSURED

Mariner Medical is concerned about the cost of healthcare. We especially are committed to assisting those without insurance to enjoy the benefits and easy accessibility of the highest quality, affordable care. The VIP Program offered by Mariner Medical covers primary and urgent care, physical examinations, immunizations and management of various chronic conditions such as diabetes, hypertension, obesity, and osteoporosis for example. For a modest annual per person fee of $149, you receive an unlimited number office visits at $65, and other appointments and procedures at 30 to 50% off customary charges. Plus you will enjoy

Payments for services under the VIP Program are expected to be made at the time of service via cash or credit card. This program is not for those covered by Medicare, Medi-Cal, nor Workers' Comp.

How to Apply for the VIP Program

You may sign up in person, download a printable version of the form below and fax or mail it to us, or you may fill out the form and submit it directly from your computer.
E-mail questions about the VIP Program to contactus@marinermedical.com.

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VIP Program Application

Name 1:

Birthdate 1: (MM/DD/YYYY)

Address:

City: State:     Zip:

Name 2:

Birthdate 2: (MM/DD/YYYY)

Name 3:

Birthdate 3: (MM/DD/YYYY)

Name 4:

Birthdate 4: (MM/DD/YYYY)

Total number of memberships requested:  

Total amount charged:

Please charge my: Card Number:

Expiration Date: (MM/YY) Security code from back of card:

E-mail address: