JetSet

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domain*
therapy*
tracking_unid*
order_id*
caller_page*
telehealth*
privacyPolicy*
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Welcome to JetSet Meds. The following questions are required to provide important information to your assigned doctor so they can properly assess your health and appropriately prescribe medications.

By clicking the "start arrow" you consent to Telehealth, Privacy Policy and Terms.

{rootdomain}{telehealth}{privacyPolicy}{terms}

Unfortunately we cannot service this condition in your state. Please contact your local physician for assistance.

Your state may require a phone or video consultation to complete your treatment. Don't worry! Your doctor will reach out to you if this is the case.

What is your email address?*
example@example.com
By checking here, you agree to receive doctor correspondences and transactional and/or marketing messaging from JetSet Meds to the email address provided above.

Please enter the phone number to reach you if the doctor has any questions regarding your medical information.*
Please enter a valid phone number.
Do you consent to receiving text messages about your prescriptions including tracking and refill information?*

YesNo
By checking this box, I consent via electronic signature to receive phone calls and/or SMS text messages to the phone number above. I understand that these calls may be generated using an automated technology, pre-recorded voices and that data rates may apply. I understand that my consent is not required to buy goods/services and I may opt out at any time to avoid receiving calls or SMS text messages.

Please acknowledge the following:*

I am seeking an evaluation by a licensed physician in order to have medications available for foreign travel to locations abroad where modern medical care is not established, to have in the event of natural disaster/emergency scenario, or because I reside in an underserved medical geographic location.I am NOT seeking antibiotics to treat an active medical diagnosis/problem.I am NOT seeking antibiotics to replace, now or in the future, routine healthcare by my primary care doctor.If prescribed, I will store medications securely and out of the access of a child.

Do you have a history of kidney disease?*

YesNo
This does not include kidney stones. This refers to conditions such as chronic kidney disease, chronic renal failure, dialysis, etc.
kidneyDisease-IMP*

Do you have a Primary Care Provider and have you had a general health checkup in the last 2 years?*

YesNo
generalHealthCheckup-IMP*

Please indicate if you have allergies to any of the medications listed:*

Penicillins (ex: amoxicillin, Augmentin, Mupirocin)Cephalosporins (ex: Ceclor, Cephalexin)Fluoroquinolones (ex: ciprofloxacin, levofloxacin)Tetracyclines (ex: doxycycline)Sulfa (ex: Bactrim, trimethoprim-sulfamethoxazole)No known drug allergiesOther
allergiesOrIntolerances-IMP*
None_1
Please uncheck "No known drug allergies" if you have other selections.

Here's your first message to your doctor. Please introduce yourself and include anything else you want them to know about your past medical history. *
Here's your first message to your doctor. Please introduce yourself and feel free to:
- Ask any questions you have
- List any medical problem you have which were not discussed above
- Include anything else you would like the doctor to know.
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moreToTellDoctor-IMP