Friends And Family - Detroit Medical Center

Welcome to our family!

At DMC, we’re taking the hassle out of healthcare, and we’re starting with you.

To enroll in the DMC Friends & Family program, and start receiving the benefits of streamlined, faster service, complete the registration form below. We’ll send you your welcome kit, including your membership card, in the mail in a few weeks.

We look forward to exceeding your expectations – thanks for choosing the DMC.

Online Registration:

Survey 1:

All fields marked with * are required

How did you hear about DMC Friends and Family?*

select

Other Source:*

select

Registration Details:

Are you a DMC Employee:*

YesNo

Enter your Legal First Name:*

Middle Initial:

Enter your Legal Last Name:*

Suffix:

Are you a Non-DMC
AFSCME Employee:*

YesNo

Address:*

Apt Number:

City:*

State:*

select

Zip Code:*

Home Phone:*

Work Phone:

Mobile Phone:

Please choose the best
contact number:

HomeBusinessMobile

Email Address:

Preferred Method of
Communication:

EmailPhoneLetter

Birthdate:*

Gender:*

select

Marital Status:*

select

Family Doctor:
Phone:

Insurance Information:

Primary Health Insurance: *
Secondary Insurance:
Name on the Insurance Card:*
Subscriber's Birthdate:*
Insurance ID Number:*
Contract/Group Number:*

Emergency Contact:

Name:

Phone:

Address:

Apt Number:

City:

State:

select

Zip:

Referring Employee:

Name:

Survey 2:

Yes, I would like to receive regular health information by
Mail and/orEmail

Security Code:

*Type Security Code:

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