Evern Student Care: Enrollment (Student 18+)

Step 1 of 5
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
It looks like you are under 18. A parent or legal guardian needs to complete this enrollment. Switch to the under-18 enrollment and we will send them a secure link.

Step 2 of 5
Legal first name
Legal last name
Preferred name
Mobile phone
Please enter a valid phone number.Format: (000) 000-0000.
Home ZIP code
School ZIP code

Step 3 of 5
Who will be responsible for payment?
If someone else pays, they enter their card on the last step of this form.
Payer full name
Payer date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Payer email
example@example.com
Payer relationship to student

Step 4 of 5

Membership summary

	Monthly	Annual
Membership	$199 a month	$1,995 a year
Registration fee, one time	$50	none
Charged today	$249	$1,995
Then	$199 a month, from day 30	$1,995 a year

Both plans include the same services. The monthly plan includes two remote advocacy and care coordination sessions a year, the annual plan includes three.

The card you enter on the next step is charged today for the amount above and then automatically at each renewal until you cancel. Cancellation and renewal terms are set out in the Evern Student Care Membership / Service Agreement (final wording is provided by Evern's attorney).

Before you continue: the amount above is charged the moment you submit, in one payment. Banks sometimes decline a larger than usual charge, and if that happens the form has to be filled in again from the start. If you think your bank might block it, call them first or use a card with enough available credit.

I have reviewed and agree to the Evern Student Care Membership / Service Agreement
I authorize the recurring charges for the selected membership and billing terms
I understand clinical consents and health information are completed separately after enrollment

Step 5 of 5

Choose your membership

Monthly Membership

$249.00 for the first month then,$199.00 for each month

Annual Membership

$1,995.00 for each year

Email for the payment receipt

Debit or Credit Card
Card number	Security code
Expiration month	Expiration year

Should be Empty: