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+1.855.816.PALS (7257) [email protected]

Smoking Cessation Referral

This page is for members who have seen a Health Pals (www.healthpals.co) Provider and have been referred for treatment via one of the subscriptions below. Upon initiating a subscription, a Pill Pals team member will verify that you have an established relationship with a Healthcare Provider.

NOTE: If you do not have an established relationship with a Healthcare Provider, you will not be permitted to initiate a treatment subscription, and your payment will be refunded. 

 

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    NOTE - Your One Time Passcode (OTP) will be sent to both your email and SMS Phone Number for your convenience
    Please enter in Phone Number in the E.164 format that includes country and area code e.g. "+1XXXXXXXXXX" for United States.
    Please enter in Phone Number in the E.164 format that includes country and area code e.g. "+1XXXXXXXXXX" for United States.
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    Date Format should be MM/DD/YYYY

    For example, December 25, 2021 is 12/25/2021
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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.

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