My Virtual Concierge Clinic

Enroll in Performance Plus

Complete the enrollment form below to begin your Performance Plus virtual concierge care membership through My Virtual Concierge Clinic.

$69/month

for 1 to 7 people in the same family group

Have questions first? Book a free 30-min call with Peter

Membership number, account status, and effective date will be confirmed after enrollment is processed.

Primary Member Information

Please provide the information for the primary member responsible for the Performance Plus membership. If you are enrolling additional family members, you will be able to add their information below.

First Name *

Last Name *

Gender *

Date of Birth *

MM/DD/YYYY

Phone Number *

Email Address *

Street Address *

Address Line 2 (optional)

City *

State *

ZIP Code *

Family Group Information

Performance Plus includes 1 to 7 people in the same family group. Please tell us how many people will be included in this membership.

Number of Individuals in Family Group *

Preferred Membership Start Date

Preferred Effective Date *

Your official effective date will be confirmed after enrollment is reviewed and processed.

Business or Organization

Please let us know if this enrollment is connected to a business, employer, nonprofit, civic group, church, association, school, or other organization. If yes, Peter Barone will contact you to discuss the details.

Is this for a business or organization? *

YesNo

If this is for a business or organization, Peter Barone will follow up with you directly to discuss the next steps.

How Did You Hear About Us?

This helps us understand how people are finding Performance Plus.

How did you hear about us?

Agent or Referral Partner Name, if applicable

Important Acknowledgments

Please read and acknowledge each statement before submitting your enrollment.

I understand that Performance Plus is a virtual concierge care membership and is not major medical insurance.I understand that Performance Plus does not replace emergency care, hospitalization, surgery, specialist care, or in-person medical evaluation when required.I understand that prescriptions are not guaranteed and depend on clinical appropriateness, provider judgment, legal requirements, and medication availability.I understand that some conditions require in-person care, lab testing, imaging, urgent evaluation, emergency care, or specialist referral.I confirm that the information provided is accurate to the best of my knowledge.

Emergency Notice: If you are experiencing chest pain, severe shortness of breath, stroke symptoms, major injury, suicidal thoughts, severe allergic reaction, uncontrolled bleeding, or any other medical emergency, call 911 or go to the nearest emergency room immediately.

Required fields are marked with *