The updated details will be lost if you go back. Do you want to go back?
This is the first page of the Registration process
The person responsible for payment must be at least 18 years old. Please review if all the information entered for the person responsible for payment is correct. Once you revise the information, click Next to go to the next page.
Information provided is incorrect.
Attention: It appears that you've made more than three unsuccessful attempts to verify your information. Please contact our front desk at ##PHONE_NUMBER## to check if the information you provided during scheduling is updated in our records.
Do you have another insurance to add?
To ensure your security, we've automatically ended your session after a page refresh. You can easily resume your work by clicking the link provided in your email or text message. Rest assured, your progress is safely saved, and you can continue from where you left off.
This may take little more than a minute
We can't find you in our system Let's fix that
Go back and confirm you typed in the correct information
Legal Name(Your name as it appears on a state-issued ID or passport)
Date of Birth(MM/DD/YYYY)
If you continue to have trouble, please reach out directly to your Care Team or emil email@example.com for assistance
Capsule Same-Day Delivery
1Get a Text from Capsule
Capsule will text you within an hour to schedule your free, same-day delivery.
2Delivery Is Free
Just pay your normal copay.
3Receive Your Medication
Capsule will deliver within a few hours. You (or someone you trust) will need to sign for it.