Experience the power of preventive healthcare Let’s get started… Your Joe Pill® online visit Step 1 of 6 16% PATIENT INFORMATIONPatient Name* First Last Patient Email* Patient Phone* Let'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 I can confirm that I am a resident of either Texas or Florida. Date of Birth using this format: (yyyy/mm/dd)* Year Month Day Gender*Select GenderMaleFemaleOther State (service only available for Texas or Florida residents)*TXFLAllergies to Medications (if no allergies to medications, type "NONE")* I confirm that I am seeking a Joe Pill® Prescription Pack™* Yes, I want a Joe Pill® Prescription Pack™ and understand the cost is $149 ($114 for medications and $35 for telemedicine visit) for the basic pack. I confirm that I am also interested in the following optional "add-ons" to my prescription pack and understand there is an additional cost to add the items below.* No Add-Ons Needed Itchy Rash / Insect Bite Triamcinolone 0.1% Cream 15 grams ($12) Gout Attack Indomethacin 50mg 20 capsules ($12) Romantic Getaway Sildenafil 100mg 30 tablets ($25) Cold Sore Package: Valacyclovir 1g tablets PLUS travel size acyclovir cream ($39) Extra Zpak? Only $9 Extra Inflammation/Rash Dose Pack? Only $12 Albuterol Inhaler Only $26 Sea Sickness Transdermal Scopolamine Patches ($36 for quantity 3 72-hour patches) Billing Address* Street Address Address Line 2 (optional) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Texas or Florida ZIP Code Is your billing address the same as your shipping address?* Yes No Shipping Address (only available in Texas or Florida)* Street Address Address Line 2 (optional) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Texas or Florida ZIP Code After hitting SUBMIT below, a Joe Pill® affiliated licensed provider will contact you by phone within 24 hours. If approved by a medical provider, prescriptions will be sent by mail promptly upon full payment.CAPTCHA đź”’ We guarantee 100% privacy. Your information will not be shared with anyone.
