DISCLAIMER: This sub-site is for use by Champion Health Members Only. Champion Health Members must login to view discounted prices. If you are not a Champion Health Member, you cannot get these deals.

Home
Join
Login
Store
$6.49 Meds
Pets & Animals
Checkout
Get Quote
See a Doctor
Info
- Overview
- Apps
- News
- Contact

0 Items

Champion Health Members can signup for Pill Pals by using the form below.

Champion Health Basic
$0.00

Signup page for Champion Health Members

* Choose A Username

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

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

Middle Name

* Last Name

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

MOBILE Phone Number in the format that includes country and area code e.g. "1XXXXXXXXXX"

I CONSENT to receiving SMS notifications

By checking the box above, I consent to receive an SMS text message to my cell number provided above for Customer Care, 2FA, Delivery Notifications , and Account Notification messages from The Health Pals Company (dba Pill Pals). I understand that I can opt-out of receiving text messages at any time by responding with STOP. I can reply with HELP to get help. Message frequency may vary. I understand that message and data rates may apply. See Health Pals's Terms of Use and Privacy Policy for more information. Consent is not a condition of purchase.

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

HOME Phone Number in the format that includes country and area code e.g. "1XXXXXXXXXX"

WORK Phone Number in the format that includes country and area code e.g. "1XXXXXXXXXX"

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. In addition, we are required by law in certain states to collect this information.

Caucasian / White

Black / African American

American Indian / Alaska Native

Hispanic / Latino

Asian

Native Hawaiian or Other Pacific Islander

* Biological Gender

Male

Female

* Are you currently pregnant?

Yes

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

* Do you have any allergies?

Yes

If YES, please list all allergies below:

* Preferred Language (e.g. English)

* Country / Region

Country/Region
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe

* Country / Region

* Address Line 1

Address Line 2

* City

* State / Region

* Zip / Postal Code

Were you referred by a friend? Enter their Name and Email Address below:

* Agree To The Terms

I Agree

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.

(Use Cropper to set image and
use mouse scroller for zoom image.)

Here's Your Payment Options

Credit or Debit Card

How do you want to pay?

Auto Debit Payment

Manual Payment

Your currently selected plan :

Already have an account? Login