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14
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2
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3
UTM_source
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4
UTM_medium
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5
UTM_campaign
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6
Are you already a Circulo member?
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If you have already signed up to be a Circulo Health member, you can schedule unlimited meetings with your health team.
Yes, I am a Circulo Health member
No, but I am interested in becoming a member
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7
Welcome! Please share your name.
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First Name
Last Name
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8
What is your birthday?
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Date
Month
Day
Year
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9
What is your email address?
example@example.com
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10
What is your phone number?
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Please enter a valid phone number.
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11
What type of health insurance do you have?
I have insurance through Medicare or Medicare Advantage
I have insurance through my employer
I have insurance through the individual market
I have insurance through Medicaid
I don't have health insurance
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12
Which organization do you get your insurance through?
MVP Health Care
CDPHP
Fidelis Care
Empire
Health Insurance Plan of Greater New York
HealthNow
New York Quality Healthcare Corporation
UnitedHealth
WellCare
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13
Circulo may be out-of-network with your insurance. Would you still like to continue & learn more?
You can still access primary health care through Circulo, but you may face higher charges for visits. Continue signing up or give us a call to learn more about your options.
Yes, I'd like to continue
No thank you
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14
What is your health insurance Member ID number?
You can find this on your insurance card or your online account
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15
What is your health insurance Group ID number?
You can find this on your insurance card or your online account
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16
Would you like Circulo to send you text messages about your health care?
It's important to be aware that SMS messages are not fully encrypted, and we cannot guarantee the privacy of messages sent via text.
Yes
No, I do not want to receive texts from Circulo
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17
Would you like to make Circulo your primary care provider?
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Yes
I'm not sure yet. Ask me again after my first visit.
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18
Welcome back! Please call or text us to meet with your health team.
(518) 900-1115
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19
Type a question
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