Payment Acknowledgment

Terms of Service

Updated July 21, 2021

Please read our policy carefully

By checking this box I authorize A (1) one-time charge to the credit card listed in this authorization form. The payment authorization is for the service of a (1) time telemedicine interaction with a doctor licensed in the state in which I reside and in the amount attached to this authorization form.

I certify that I am an authorized user of this card and will not dispute this payment with my card company, so long as the transaction corresponds to terms indicated in this form.