Skip to content
Home
Stories
Articles
About Us
Providers
Supporters
Making Medical History 2022
Share Us
Membership
Contact Us
Menu
Home
Stories
Articles
About Us
Providers
Supporters
Making Medical History 2022
Share Us
Membership
Contact Us
Donate
Donate
Thank you!
Thank you for becoming a Supporting Practice!
Please enable JavaScript in your browser to complete this form.
Supporting Practice - Yearly
Price:
$500.00
Includes Membership for up to 3 providers. $500 per year on recurring payment
Name
*
First
Last
Your Email
*
Email address of user(s)
List up to 3 email addresses for the users that will receive access to Pract-Us
Address
*
Address Line 1
City
State / Province / Region
Are you a medical provider?
*
Yes
No
What is your title?
*
What is your specialty?
*
Who is your employer?
*
How are you affiliated with NCPFF?
*
What is your profession?
*
Are you affiliated with NCPFF?
*
Yes
No
How did you hear about NCPFF?
*
Who referred you to NCPFF?
*
We agree with the mission statement of NCPFF?
*
Yes
Our Mission: North Carolina Physicians for Freedom is a non-profit network of physicians, healthcare leaders and medical providers that exists to support medical freedom and patient choice. We stand for patient rights, the doctor-patient relationship, individualized patient care, informed consent, and medical privacy. We are committed to serving our patients with integrity and compassion and will advocate for the best care available.
We agree to the terms of service of NCPFF Pract-Us
*
Yes
Terms of Service: You are responsible for safeguarding Your password and any activities under Your password. Do not disclose Your password to any third party. You must notify Us immediately of any breach of security or unauthorized use of Your account. You are responsible for the Content that You post to the Service, and for all activity that occurs under your account, including its legality, reliability, and appropriateness. You agree to use the Service at your own risk. NC Physicians For Freedom and its contractors will not be liable for any content, including any errors or omissions in any content, or any loss or damage of any kind incurred as a result of your use of any content or use of the Service. We may terminate or suspend Your Account immediately, without prior notice or liability, for any reason whatsoever, including without limitation if You breach these Terms of Service.
Payment Information
*
Card
Name on Card
Submit
Thank you for donating to North Carolina Physicians For Freedom
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you want to make a recurring donation?
No, I want to make a one time donation.
Yes, I want to donate monthly.
Donation Amount
$25.00
$50.00
$100.00
Other Amount
Donation Amount
Minimum Price: $10.00
Stripe Credit Card
*
Card
Name on Card
Message
*
We would like to contact you about our services, as well as other content that may be of interest to you.
I agree to receive other communications from North Carolina Physicians For Freedom.
Send Donation