Call A Doctor Plus - Group Election Form

Please complete the information requested below and we will contact you to get you and your staff enrolled as quickly as possible.

Company Name*

Contact Phone*

Your Name*

Your Email*

Virtual Care Plan Choice:EnhancedElite

Which employees do you want to cover? (Choose all that apply)Full TimePart TimeOwners (not on payroll)Independent Contractors

ACKNOWLEDGEMENTS

I am aware that my company will be billed directly by Call A Doctor Plus.

I acknowledge and understand that the plan must be made available to ALL employees/staff in the categories selected, so as to avoid any discrimination issues.

I hereby request that a member of the Outstaffing team call me to initiate set-up for my group and enroll my staff in the Outstaffing Virtual Care plan of my choice.

Upload your employee groups or individuals on your Group Administrator Page.