Joe Pill® Appointment Information (Karen Little, NP) PATIENT INFORMATIONLet's get started... Before we gather your patient information, please click below to agree to the Joe Pill® Terms & Conditions, Privacy Policy and Telehealth Consent:* Yes, I agree to the Joe Pill® Terms & Conditions, Privacy Policy, and Telehealth Consent and am a resident of Texas. Patient Name* First Last Date of Birth using this format: (yyyy/mm/dd)* Year Month Day Gender*Select GenderMaleFemaleOtherState (service only available for Texas residents)*TXAllergies to Medications (if no allergies to medications, type "NONE")*Patient Email* Patient Phone*I am seeking treatment for the following:*Prescription Travel Pack™ ($149)Cold Sore/Antiviral ($79)Erectile Dysfunction ($79)Billing Address* Street Address Address Line 2 (optional) City ZIP Code Is your billing address the same as your shipping address?* Yes No Shipping Address (only available in Texas)* Street Address Address Line 2 (optional) City ZIP Code After hitting SUBMIT below, we will send an email with a secure link for payment. Approved prescriptions will be sent by mail promptly upon payment.