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: