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To join CAPS+ or one of our alternative programs, simply fill in the following fields and enroll securely online. If you would like to speak with a member of our staff to answer any questions or to enroll over the phone please call 1-866-362-3627.

* First Name:
* Last Name:
Degree:
Practice Name:
Medical Associations:
Prefix:
* Street Address:
Suite:
* City:
* State:
* Zip Code :
* Primary Contact Method:	-Select- Mail Primary Phone Secondary Phone Fax or Email
* Primary Phone:
Secondary Phone:
Fax Number:
Office Manager:
* Email:
Fma Member #:
Special Requests:
Choose your payment preference:
Please email me an electronic invoice to be paid by credit card. OR Phone us at: 1-866-362-3627 to pay by credit card. OR Send your check to: Physicians Advantage One Independent Drive Suite 3201 Jacksonville, Florida 32202