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 confirm that I am seeking a Joe Pill® Prescription Travel Pack™:* Yes, I want a travel pack and understand the cost is $149 for the base travel pack. I confirm that I am also interested in the following "add-ons" to my travel pack and understand there is an additional cost to add the items below.* Sea Sickness Transdermal Scopolamine Patches ($36 for qty 3) Itchy Rash / Insect Bite Triamcinolone 0.1% Cream 30 gram tube($12) Gout Attack Indomethacin 50mg 20 capsules ($12) Romantic Getaway Viagra® (sildenafil) 100mg 30 capsules ($25) Cold Sore Package: Valtrex® (valacyclovir) tablets PLUS travel size acyclovir cream ($39) Extra Zpak? Only $9 Extra Medrol Dose Pack? Only $12 No "Add-ons" Are Desired At This Time 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.
