Photograph your Insurance Card

Take a photo of your ID and then select Use Photo

Front side

Place the card within the outline. Make sure the card to be centre and within the outline.

Front side

Place the card within the outline. Make sure the card to be centre and within the outline.

Retake? Go back without using photo

Front

Back

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Confirmation message

Do you want to complete the Open questions?

Please select a Zip Code

Zipcode

Confirmation message

The updated details will be lost if you go back. Do you want to go back?

No Page

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.

If you think this is a mistake. Please see the front desk staff and ask them to correct your information. Once they do try again from here.

Do you have another insurance to add for this visit?

Yes

No

Your session was expired. You refreshed your page and for security reasons we expired your session. Please go back to your email/text message click the link again and start the paperwork. Information you entered so far will be stored and you will be asked to verify your identity.

Please wait...

This may take little more than a minute

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.

Still have question?

Learn more about how Capsule works on their Website, or view their FAQs more?.

Crop Image

You can adjust the card to fit in the frame by dragging the orange scale below the image before saving