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.
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?
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.
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.