Selecting Your Provider

Are you currently a member of Hickory Medical?
Which provider would you like for you/your family?
Adults: $49/month, Children: $21/month. $20/visit
Adults: $40/month, Children: $21/month, $20/visit
Do you have Medicare (over 65, on disability or other Medicare)?
How would you like to complete your paperwork?
Can be done in your web browser on your computer or phone. You do not need to print anything out.
You can print this form out, complete the paper form, then get it to the office.
You need to complete a form for each member of your family. Once your form has been completed, Dr. Ryan Kauffman, MD FAAFP will serve as your primary care provider.  Except for limited times when he will be covered by his partner, Dr. Ryan will see you for your visits, manage prescriptions, and generally be your physician.  This membership is $49/month for adults, $21/month for children.

Click the button below to go to SignNow to complete your form online.   When you complete the form (and click done) it will be automatically submitted to Hickory Medical.

SignNow
You need to complete a form for each member of your family. Once your form has been received by Hickory, Dr. Ryan Kauffman, MD FAAFP will serve as your primary care provider.  Except for limited times when he will be covered by his partner, Dr. Ryan will see you for your visits, manage prescriptions, and generally be your physician.  This membership is $49/month for adults, $21/month for children.

Click the button below to open the PDF document of the form.   You can print the form, then submit the paper form.

Download
You need to complete a form for each member of your family. Once your form has been completed, Dr. Ryan Kauffman, MD FAAFP will serve as your primary care provider.  Except for limited times when he will be covered by his partner, Dr. Ryan will see you for your visits, manage prescriptions, and generally be your physician.  This membership is $49/month for adults, $21/month for children.

Click the button below to go to SignNow to complete your form online.   When you complete the form (and click done) it will be automatically submitted to Hickory Medical.

SignNow
You need to complete a form for each member of your family. Once your form has been received by Hickory, Dr. Ryan Kauffman, MD FAAFP will serve as your primary care provider.  Except for limited times when he will be covered by his partner, Dr. Ryan will see you for your visits, manage prescriptions, and generally be your physician.  This membership is $49/month for adults, $21/month for children.

Click the button below to open the PDF document of the form.   You can print the form, then submit the paper form.

Download
You need to complete a form for each member of your family. Once your form has been completed, A Nurse Practitioner or Physician’s Assistant will serve as your primary care provider. Excepted for limited times when there will be cross coverage, this provider will see you for your visits, and manage prescriptions. This membership is $40/month for adults, $21/month for children. We are currently in the hiring process for this position and will provide details about the provider here as soon as we have them.

Click the button below to go to SignNow to complete your form online.   When you complete the form (and click done) it will be automatically submitted to Hickory Medical.

SignNow
You need to complete a form for each member of your family. Once your form has been received by Hickory, A Nurse Practitioner or Physician’s Assistant will serve as your primary care provider. Excepted for limited times when there will be cross coverage, this provider will see you for your visits, and manage prescriptions. This membership is $40/month for adults, $21/month for children. We are currently in the hiring process for this position and will provide details about the provider here as soon as we have them.

Click the button below to open the PDF document of the form.   You can print the form, then submit the paper form.

Download
You need to complete a form for each member of your family. Once your form has been completed, A Nurse Practitioner or Physician’s Assistant will serve as your primary care provider. Excepted for limited times when there will be cross coverage, this provider will see you for your visits, and manage prescriptions. This membership is $40/month for adults, $21/month for children. We are currently in the hiring process for this position and will provide details about the provider here as soon as we have them.

Click the button below to go to SignNow to complete your form online.   When you complete the form (and click done) it will be automatically submitted to Hickory Medical.

SignNow
You need to complete a form for each member of your family. Once your form has been received by Hickory, A Nurse Practitioner or Physician’s Assistant will serve as your primary care provider. Excepted for limited times when there will be cross coverage, this provider will see you for your visits, and manage prescriptions. This membership is $40/month for adults, $21/month for children. We are currently in the hiring process for this position and will provide details about the provider here as soon as we have them.

Click the button below to open the PDF document of the form.   You can print the form, then submit the paper form.

Download
You need to complete a form for each member of your family who is joining. Once your form has been completed, Dr. Ryan Kauffman, MD FAAFP will serve as your primary care provider.  Except for limited times when he will be covered by his partner, Dr. Ryan will see you for your visits, manage prescriptions, and generally be your physician.  This membership is $49/month for adults, $21/month for children.  Existing patients will continue at their current rate until 4/1/21.

Click the button below to go to SignNow to complete your form online.   When you complete the form (and click done) it will be automatically submitted to Hickory Medical.

SignNow
You need to complete a form for each member of your family who is joining. Once your form has been received by Hickory, Dr. Ryan Kauffman, MD FAAFP will serve as your primary care provider.  Except for limited times when he will be covered by his partner, Dr. Ryan will see you for your visits, manage prescriptions, and generally be your physician.  This membership is $49/month for adults, $21/month for children. Existing patients will continue at their current rate until 4/1/21.

Click the button below to open the PDF document of the form.   You can print the form, then submit the paper form.

Download
You need to complete a form for each member of your family who is joining. Once your form has been completed, A Nurse Practitioner or Physician’s Assistant will serve as your primary care provider. Excepted for limited times when there will be cross coverage, this provider will see you for your visits, and manage prescriptions. This membership is $40/month for adults, $21/month for children. We are currently in the hiring process for this position and will provide details about the provider here as soon as we have them.   Your cost will change for your next month of membership.

Click the button below to go to SignNow to complete your form online.   When you complete the form (and click done) it will be automatically submitted to Hickory Medical.

SignNow
You need to complete a form for each member of your family who is joining. Once your form has been received by Hickory, A Nurse Practitioner or Physician’s Assistant will serve as your primary care provider. Except for limited times when there will be cross coverage, this provider will see you for your visits, and manage prescriptions. This membership is $40/month for adults, $21/month for children. We are currently in the hiring process for this position and will provide details about the provider here as soon as we have them. Your cost will change for your next month of membership.

Click the button below to open the PDF document of the form.   You can print the form, then submit the paper form.

Download