Ready to enroll? Use this form to start your enrollment process.

Instructions:

After completing this form, press Ready to Enroll! and you will be directed to a separate enrollment form connected to our Electronic Medical Records
You are able to enroll multiple children using this form
Do not click “Enter Additional Details” as this takes you to a long form intended for adults that we do not use
At the end of the enrollment form, you will be asked to provide your credit card information, which will be used to charge your family’s one-time Enrollment Fee
You will be able to choose how your subscription is billed moving forward
Please reach out to admin@clepeds.com with any questions!

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Name

First Name

Last Name

Phone number

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###

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Names and ages of the children in your family who will be enrolled

How did you hear about us?

Ready to enroll? Use this form to start your enrollment process.

Address

Contact

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