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Strength: Very Weak

* Confirm Password (at least 12 characters, one Uppercase letter, one Lowercase letter, one Number, and one Special Character)

* Email Address

* First Name

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Send SMS notification

* Date of Birth (MM/DD/YYYY) For example, December 25, 2021 is 12/25/2021

Race / Ethnicity - Please provide us with this information so that we can manage your care. Some drugs may have variable effects in different racial/ethnic groups.

* Biological Gender

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* Are you currently pregnant?

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If YES, when is your due date? (MM/DD/YYYY) For example, December 25, 2021 is 12/25/2021

* Do you have any allergies?

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If YES, please list all allergies below:

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By checking the box above, I am indicating that I agree to the Privacy Policy and Terms of Use of the Pill Pals website. In addition, I have read the Electronic Signature Consent Statement, HIPAA Authorization & Disclosure, and Disclaimer pages.

Text Message / SMS Consent

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By checking this box and signing up for texts, you consent to receive text messages (e.g. account notifications and status reminders). Consent is not a condition of purchase. Msg & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP or clicking the unsubscribe button link (where available).

NOTE - Your One Time Passcode (OTP) will be sent to both your email and SMS Phone Number for your convenience