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Lithia Motors Members can signup for Pill Pals by using the form below.

Lithia and Driveway (LAD)
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Signup page for Lithia and Driveway Members

EMPLOYEE INFORMATION

This Drug Discount Program is a benefit for Employees and their immediate family members only. Eligible individuals include:

* Employees

* Their Spouse / Partner

* Their Children (includes Biological, Adopted, and Stepchildren)

* All Pets / Animals in the Household

Please provide the Employee's Full Name, Date of Birth, and Work Email in the sections below, to verify your registration.

* Employee's Name

* Employee's Work Email

* Employee's Date of Birth

YOUR INFORMATION

Please provide your information in the section below.

Your Information

* Relationship to Employee

Select Option
Self (I am the Employee)
Spouse/Partner
Child
Pet/Animal

* Relationship to Employee

* 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"

Send SMS notification

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
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Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
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Azerbaijan
Bahamas
Bahrain
Bangladesh
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Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
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Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
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East Timor
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Egypt
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Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
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Guinea
Guinea-Bissau
Guyana
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Israel
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Japan
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Kuwait
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Laos
Latvia
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Liberia
Libya
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Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
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Micronesia
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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.

Text Message / SMS Consent

Sign me up for text alerts!

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

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