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PillClub register by Mind Map: PillClub register

1. I'll add photos of my insurance card now.

1.1. Insurance Card

1.1.1. front photo

1.1.2. back photo

1.2. Whose insurance plan is this?

1.2.1. My parents insurance plan

1.2.1.1. First Name of insurance plan owner *

1.2.1.2. Last Name of insurance plan owner *

1.2.1.3. Date of Birth of insurance plan owner *

1.2.1.4. Address of insurance plan owner *

1.2.2. My own insurance

1.2.3. My spouse's insurance plan

1.3. Would you like a 1-year supply of birth control if your insurance covers it?

2. I'll send my insurance info later.

2.1. Please note: We'll need your insurance information to process your request. Text pictures to 44872 (or 772-217-4557) Would you like a 1-year supply of birth control if your insurance covers it?

2.1.1. Yes

2.1.2. No

3. I don't have insurance.

3.1. NEXT

3.1.1. When would you like your first prescription from us delivered?

3.1.1.1. Enter date (MM/DD/YYYY)

3.1.1.1.1. What's your mailing address?

4. Are you pregnant?

4.1. Yes

4.2. No

4.2.1. Please Note: By answering you are not pregnant, you’re agreeing that: You’ve had your period within the last 7 days or haven’t had sexual intercourse since your last period. You’re correctly and consistently using a reliable form of contraception; or you’ve had a miscarriage or abortion within the last 7 days. Обратите внимание: отвечая, что вы не беременны, вы соглашаетесь с тем, что: у вас был период в течение последних 7 дней или у вас не было половых контактов с момента последнего периода. Вы правильно и последовательно используете надежную форму контрацепции; или у вас был выкидыш или аборт в течение последних 7 дней.

5. Within the last 6 months, what was your most recent blood pressure?

5.1. Low to Normal (120/80 or lower).

5.2. Above Normal (between 121/80 to 129/80).

5.3. High (130/81 to 139/89).

5.3.1. We Recommend POP for High Blood Pressure Since you indicated you have high blood pressure, we recommend birth control without estrogen. This is known as the progestin-only pill (POP). Please note, contraceptives with estrogen may further increase your blood pressure and risk for cardiovascular issues. Please Note: You may not skip periods while taking the POP. You must take the POP at the same time every day because there are higher rates of pregnancy if taken more than 3 hours late. Are you interested in moving forward with the POP?

5.3.1.1. Yes

5.3.1.1.1. Remember that you must take the POP at the same time every day, as pregnancy rates may be higher if taken more than 3 hours late. Don't forget to use a backup method of contraception for the first 7 days. And by the way, skipping periods is not possible on the POP.

5.3.1.2. No

5.3.1.2.1. Your blood pressure may put you at increased risk of serious health issues if you take an estrogen-containing pill, patch, or ring. By selecting “yes” below, you are acknowledging that you understand the education and precautions reviewed with you and would still prefer to proceed without a POP. Our medical team is also here to answer questions if you should have any; just send us a text!

5.4. Higher (greater than 140/90)

6. Do any of the following apply to you?

6.1. None.

6.2. Diabetes for 20+ years or any diabetes-related complications.

6.3. Heart attack or stroke.

6.4. Heart conditions (atherosclerosis, high cholesterol, ischemic heart disease, valvular heart disease, vascular disease).

6.5. Blood clot in the legs or lungs, clotting disorder, or at risk for developing blood clots.

6.6. Bariatric surgery.

6.7. Inflammatory bowel disease(ulcerative colitis or Crohn’s disease).

6.8. Major surgery recently or in the last 6 weeks.

6.9. Have had or currently have breast cancer.

6.10. Liver issues (cirrhosis, gallbladder issues, liver tumors, hepatitis).

6.11. Lupus

6.12. Organ transplant.

6.13. Currently a smoker.

6.14. Advised not to take hormones by a healthcare professional.

6.14.1. Can you please provide more details?

6.15. Migraines with aura.

6.15.1. Is your existing prescription for POP (also known as progestin-only or minipill)?

6.15.1.1. Yes

6.15.1.2. No

6.16. Currently taking any of the following medications: Phenytoin, Carbamazepine, Barbituates, Primidone, Topiramate, Oxcarbzepine, Lamotrigine, Rifambin, Rifabutin, Fosamprevanir.

7. Can we send you a more affordable brand?

7.1. Yes, please

7.2. Keep me on my preferred brand

8. What birth control or method you’re on?

8.1. Tell us the drug name and dosage

8.1.1. Search drug

8.2. Take a photo of the medication or prescription

8.2.1. download

8.3. Text in the photo later

9. NEXT

10. How would you like to provide your insurance?

11. What's your mailing address?

11.1. How did you hear about Pill Club?

11.1.1. I saw an ad

11.1.2. A friend mentioned it to me

11.1.3. A social blogger mentioned it

11.1.4. Google / Web Search

11.1.5. I read an article

11.1.6. Other

12. Next

13. What's your mailing address?

13.1. Choose your plan

13.1.1. Every month 15,00 $ 15,00 $ / pack

13.1.2. Every month 15,00 $ 15,00 $ / pack

13.1.3. Every month 15,00 $ 15,00 $ / pack

14. How would you like to provide your insurance?

14.1. I don't have insurance.

14.2. I'll send my insurance info later.

14.2.1. Would you like a 1-year supply of birth control if your insurance covers it?

14.2.1.1. Yes

14.2.1.2. No

14.3. I'll add photos of my insurance card now.

14.3.1. Would you like a 1-year supply of birth control if your insurance covers it?

14.3.1.1. Yes

14.3.1.2. No

15. Next

16. Are you currently taking any of the following medications?

16.1. None.

16.2. Certain Anticonvulsants

16.3. Certain Antibiotics

16.4. Barbiturates.

16.5. Fosamprenavir.

17. Have you ever experienced a migraine headache with an aura?

17.1. Yes

17.1.1. Are you interested in moving forward with the POP?

17.1.1.1. Yes

17.1.1.2. No

17.2. No

18. Do any of the following apply to you?

18.1. None.

18.2. Diabetes for 20+ years or any diabetes-related complications.

18.3. Heart attack or stroke.

18.4. Heart conditions (atherosclerosis, high cholesterol, ischemic heart disease, valvular heart disease, vascular disease).

18.5. Blood clot in the legs or lungs, clotting disorder or at risk for developing blood clots.

18.6. Bariatric surgery.

18.7. Inflammatory bowel disease (ulcerative colitis & Crohn’s disease).

18.8. Major surgery in the last 6 weeks.

18.9. Have had or currently have breast cancer.

18.10. Liver issues (cirrhosis, gallbladder issues, liver tumors, hepatitis).

18.11. Lupus.

18.12. Organ transplant.

18.13. Advised by a medical professional not to take hormones.

19. Next

20. Next

21. Are you currently breastfeeding?

21.1. Yes

21.2. No

22. Have you delivered a baby in the last 3 weeks?

22.1. Yes

22.1.1. Are you interested in moving forward with the POP?

22.1.1.1. Yes

22.1.1.2. No

22.2. No

23. Are you pregnant?

23.1. Yes

23.2. No

24. Choose a method: Need help?

24.1. Pill

24.1.1. Any brand preference?

24.1.1.1. Yes

24.1.1.2. No

24.2. Ring

25. Are you a current smoker?

25.1. Yes

25.2. No

26. Within the last 6 months, what was your most recent blood pressure?

26.1. Low to Normal (120/80 or lower).

26.2. Above Normal (between 121/80 to 129/80).

26.3. High (130/81 to 139/89).

26.3.1. Are you interested in moving forward with the POP?

26.3.1.1. Yes

26.3.1.2. No

26.3.1.2.1. Your blood pressure may put you at increased risk of serious health issues if you take an estrogen-containing pill, or ring. By selecting “yes” below, you are acknowledging that you understand the education and precautions reviewed with you and would still prefer to proceed without a POP. Our medical team is also here to answer questions if you should have any; just send us a text!

26.4. Higher (greater than 140/90)

27. Have you ever been on birth control before?

27.1. Yes

27.1.1. Is there anything you'd like to let us know about your experience using birth control? Please let us know if:

27.2. no

28. Weight

29. Height

30. I'd like The Pill Club to write me a new prescription.

31. I'd like The Pill Club to renew my existing prescription.

32. Account Name Medicine Allergies Last Name