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About Us

Our Services

Home

About Us

Our Services

MedMembership

Addiction Treatment Service

Take the First Step Toward a Healthier You

Welcome to MedMembership!

ADDICTION TREATMENT SERVICE Features:

Suboxone or Buprenorphine options:
Medications that help manage cravings, withdrawal symptoms, and cravings for opioid use disorder.

Costs varies on dosing and advised medication treatment.

Personalized treatment plans: Tailored treatment that addresses both the physical and emotional aspects of addiction recovery.

Access to support groups and counseling: Group therapy and one-on-one counseling sessions provide critical emotional support.

Flexible telehealth visits: Access to addiction care via secure virtual consultations, making recovery convenient and private.

We are excited to be part of your journey toward complete health and wellness. Please take a few moments to fill out this intake form for Addiction Treatment Service. Your answers will help us tailor our services to best meet your needs and ensure a smooth start to your care with us.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Birthdate *

(###)

###

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Gender *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referral/Source

What services are you interested in?

Addiction Recovery

What are you hoping to accomplish through our Addiction Recovery Services? *

Primary Care History *

Have you had a primary care provider in the past?

YES

Do you have any chronic medical conditions? (e.g., diabetes, hypertension, thyroid disorder) *

YES

Are you currently taking any medications?

If yes, please list:

Do you have any allergies?

If yes, please list:

Description of any health symptoms you are currently experiencing:

Do you struggle with overuse of alcohol? *

YES

Do you struggle with overuse of medications? *

YES

Do you struggle with overuse of substances? *

YES

Terms and Conditions *

I hereby consent to the use of telemedicine services, which may include consultations and follow-ups via secure video or phone calls. I understand that MedMembership operates on a direct-pay model and does not bill insurance for services. However, I understand that some services (such as lab work) may be billable through my insurance, depending on my plan. I acknowledge that MedMembership may require a deposit for securing my initial appointment, which will be applied toward my services at checkout. I agree to provide accurate and up-to-date information and will notify MedMembership of any changes in my health, medications, or insurance. By signing below, I acknowledge that the information provided is accurate to the best of my knowledge and that I consent to the use of MedMembership’s services in accordance with the policies outlined.

Next Steps:

Once you’ve completed the form, our team will review your information and reach out within 24 hours to process your records and schedule appointment depending on the service chosen. Thank you for choosing MedMembership! We look forward to supporting you on your health journey. Thank you for choosing MedMembership! We look forward to supporting you on your health journey.

Thank you!

Location:

229 Rugged Creek Dr
Stockbridge, GA 30281

Contact Us:

info@medmembership.com
(678)-916-4100

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