Heritage Membership Sign-up

Heritage Membership

You Are On Your Way To Becoming a Member of Heritage Victor Valley Medical Group! Fill out and submit this form. Member Services will get in contact with you shortly to initiate your membership.

How Can We Help You?
- Check the box to receive a call from us to answer any questions you have.
Would you like to receive updates on health, wellness and fitness opportunities via text?
- Check the box, include your cell number and you may receive 2 texts per month. Consent is not a condition of purchase, only to receive text offers sent by an automatic dialing system. Message & data rates may apply. T/C & privacy policy @ hvvmg.com/sms-terms
What program are you interested in?
Name:*
First Last
Date of Birth:*
Current Primary Care Physician:
Current Health Insurance Company:
Cell Phone:
Email:
Signature (sign with your curser)*
Thank you for your interest. You will be contacted shortly by a Heritage membership specialist

760-261-6400 or 1-800-655-9999

members@www.hvvmg.com