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Let’s get started
Before your visit, please complete
your patient profile.

Patient info

First name

John

Last name

Smith

Phone number

(628) 267-9041
Date of birth

MM/DD/YYYY

02/18/1995 v
Biological sex
@ ANl ~

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Acne Treatment and Prevention
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Medical History
< Photos
Medical history
It's important that we have a complete
picture of your health so that we can give
you the best care. Add your medical history
here.
Medical conditions + Add
None Added
Surgeries or hospitalizations + Add
None Added
No medical history
Please message us to correct any of the
above information.
|AELE Use Photo
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@ Male
O Female
Current address
This helps us connect you with a local
provider.

Address line 1

1226 University Drive

Address line 2

City

Menlo Park

State

v

California

Zip code

94025

Start visit

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Acne Treatment and Prevention X
@ All photos are fully encrypted and
accessible only to authorized clinical
staff.
Selfie
Take a picture of your face. This is
to verify your identity.
Retake photo Upload photo
@ Uploaded
ID =
Take a picture of a government
issued ID that has your picture,
name, and date of birth. This is to
verify your identity.
Take photo Upload photo
Photo Library
Take Photo
- Choose File 5
|9:41 -Ill ? @'
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Acne Treatment and Prevention
GED CGEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 1 of 7
After answering a few short
questions, our medical team will be
able to help you get the care you
need for your acne. However, please
know that we are unable to
prescribe the severe acne
medication isotretinoin (also known
as Accutane, Zenatane, Absorica,
Myorisan, Claravis, or Amnesteem)

(] I'understand.
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Acne Treatment and Prevention X
|9:41 all F @)
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Acne Treatment and Prevention
GEEED GEEED
Intake Interview
< Getting Started

Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 7 of 7
Last question! Do any of the
following currently apply to you?
Certain conditions can increase risks or
change the treatments we recommended for
you.

(] Breastfeeding

(] Immune system problems

(] Pregnant
|9:41 -Ill ? @'
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Acne Treatment and Prevention
GEEED CGEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
“Q
+
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Almost done!
We've got almost everything we need to get
you the right treatment. Just a few more
questions to go!
|9:41 -Ill ? @'
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Acne Treatment and Prevention
GEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 3 of 7
What acne symptoms have you had
recently?
(] Blackheads
Broken or spidery blood vessels
(] Bumps after shaving
[j Deep, large, or painful pimples
|9:41 -Ill ? @'
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Acne Treatment and Prevention
GED CGEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 1 of 7
After answering a few short
questions, our medical team will be
able to help you get the care you
need for your acne. However, please
know that we are unable to
prescribe the severe acne
medication isotretinoin (also known
as Accutane, Zenatane, Absorica,
Myorisan, Claravis, or Amnesteem)

| understand.
|9:41 -Ill ? @'
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Acne Treatment and Prevention
CGEED GEEED GEEED GEEED
Verify ID
Identity verification
Next, let's verify your identity. This is
required by federal law to allow us to treat
you and prescribe you medication.

@ All photos are fully encrypted and
accessible only to authorized clinical
staff.

Selfie a
Take a picture of your face. This is
to verify your identity.
Take photo Upload photo
Photo Library
IC Take Photo
T,i m
C
isc Choose File 5
name, and date of birth. This is to
|9:41 -Ill ? @'
Acne Treatment and Prevention X
Left face =
Please take a close up picture of
the left side of your face.
Take photo Upload photo
Right face =
Please take a close up picture of
the right side of your face.
Take photo Upload photo
® Optional
Upper area of shoulders a
Please take a picture of the top
area of your shoulders.
Take photo Upload photo
|9:41 all F @)
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Acne Treatment and Prevention
GEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 5 of 7
What other medications or
treatments have you tried?
This helps make sure we don't recommend
anything that didn't work for you before.
[3 Benzoyl peroxide or ProActiv
(] Differin or adapalene
(] Oral antibiotics (doxycycline,
Bactrim)
|9:41 -Ill ? @'
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() Refill my existing medication
O Change to a different treatment plan
@ Other
What goals are most important to
you?
(] Works fast
(] Affordable or low cost
(] Prefer topical only
(] Prevent future acne
(] Less wrinkles and fine lines
|9:41 all ¥ @
Acne Treatment and Prevention X
() Refill my existing medication
O Change to a different treatment plan
@ Other
What goals are most important to
you?
Works fast
Affordable or low cost
Prefer topical only
(] Prevent future acne
(] Less wrinkles and fine lines
|9:41 all ¥ @
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Acne Treatment and Prevention
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How does this work?
. Answer some simple medical N
questions.
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questions that will help our medical providers
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care.
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. nurse over secure text within v
minutes.
. Get your prescription same-day. v
m _ \ﬂ ‘
|9:41 all © @
Acne Treatment and Prevention X
X
Q. Fracture X
Nasal Fracture Reduction X
Elevate Skull Fracture Fragments +
Vertebral Fracture Repair +
Turbinate Fracture +
Nasal Fracture Reduction & Added
Closed Reduction of Nasal Fracture +
Open Reduction of Nasal Fracture +
Il arnvinAnAal Crantiira DanAair —I—
|9:41 all T (@)
Acne Treatment and Prevention X
X
Q. Fracture X
Nasal Fracture Reduction X
Closed Reduction of Nasal Fracture X
Elevate Skull Fracture Fragments +
Vertebral Fracture Repair +
Turbinate Fracture +
Nasal Fracture Reduction ® Added
Closed Reduction of Nasal
® Added
Fracture
|9:41 all F @)
Acne Treatment and Prevention X
X
What surgeries or
hospitalizations have you
had?
List all the procedures and events and try
to estimate when they occurred.
|9:41 all F @)
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Acne Treatment and Prevention
CGEED GEEED GEEED GEEED GEEED
Photos
< Verify ID
Diagnostic photos
For this visit, we need a few specific photos
to help your provider accurately assess your
medical condition.

@ All photos are fully encrypted and
accessible only to authorized clinical
staff.

Left face =
Please take a close up picture of
the left side of your face.

Take photo Upload photo
Right face a
Please take a close up picture of
|9:41 all ¥ @
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Acne Treatment and Prevention
CGEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 2 of 7
How can we help you today?
Q Recommend an acne treatment plan
for me
Q Start a specific treatment plan
Q Refill my existing medication
Q Change to a different treatment plan
Q Other
|9:41 all ¥ @
Acne Treatment and Prevention X
@ Other
What goals are most important to
you?
Works fast
Affordable or low cost
Prefer topical only
(] Prevent future acne
(] Less wrinkles and fine lines
(] Something else
|)
4
PHOTO
Cancel @
|9:41 all ¥ @
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@ All photos are fully encrypted and
accessible only to authorized clinical
staff.
Selfie
Take a picture of your face. This is
to verify your identity.
Retake photo Upload photo
@ Uploaded
ID
Take a picture of a government
issued ID that has your picture,
name, and date of birth. This is to
verify your identity.
Retake photo Upload photo
@ Uploaded
|9:41 -Ill ? (I
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Acne Treatment and
Prevention
#V-QSVNOLOIS6
Visit status
Ready for provider, 07/24/2023
Your visit is now being processed and we’'ll
notify you when the doctor has reviewed it.
Check your messages in case our clinical
team has any follow up questions.
Visit costs
Total $19
Photos
|9:41 all ¥ @
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CGEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 6 of 7
Do you notice any changes with your
acne around your period?
Q Not relevant. | don't get periods.
|9:41 -Ill ? (I

Acne Treatment and Prevention X
Your visit is now being processed and we’'ll
notify you when the doctor has reviewed it.
Check your messages in case our clinical
team has any follow up questions.
Visit costs
Total $19
Photos
Notifications
Text notifications Off
Need help?

[

Please send us a message.
|9:41 all ¥ @

Acne Treatment and Prevention X
An experienced healthcare provider will
evaluate your condition and discuss
treatment options at an exclusive member
rate.
Amount due $19.00
You might see a hold but won't be charged until
your medical visit is complete.
Payment method
Payment information is protected and
encrypted.

00002970
@ VISA _
Expires 01/24
Q New credit/debit card
By clicking ‘Confirm and pay $19.00’ below, you
understand and agree to the Agreement for Self-
Payment of Services and shall pay these charges in
full as a self-pay patient electing not to use an
insurance policy benefit. Visits are conducted by
doctors or nurse practitioners.
7 Submitting visit payment...
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|9:41 il F ()
& | MESSAGES
@ Male
O Female
Current address
This helps us connect you with a local
provider.

Address line 1

Address line 2

Start visit

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|9: 41 all § @m)
Acne Treatment and Prevention X
|9:41 all ¥ @

Acne Treatment and Prevention X
An experienced healthcare provider will
evaluate your condition and discuss
treatment options at an exclusive member
rate.
Amount due $19.00
You might see a hold but won’t be charged until
your medical visit is complete.
Payment method
Payment information is protected and
encrypted.

00002970
@ VISA _
Expires 01/24
O New credit/debit card
By clicking ‘Confirm and pay $19.00’ below, you
understand and agree to the Agreement for Self-
Payment of Services and shall pay these charges in
full as a self-pay patient electing not to use an
insurance policy benefit. Visits are conducted by
doctors or nurse practitioners.
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Confirm your location
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State
California v
|9:41 all ¥ @
Acne Treatment and Prevention X
—
X

Elevate Skull Fracture Fragments +
Vertebral Fracture Repair +
Turbinate Fracture +
Nasal Fracture Reduction +
Closed Reduction of Nasal Fracture +
Open Reduction of Nasal Fracture +
Laryngeal Fracture Repair +
Reduction of Facial Fracture +
Reduction of eeremmmmmm———"0 ;
|9:41 -Ill ? @'
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Confirm your location
We’'ll match you to a local healthcare provider
licensed in your state.
State
California v
|9:41 all F @)
& | MESSAGES
Let’s get started
Before your visit, please complete
your patient profile.

Patient info
Date of birth

MM/DD/YYYY
Biological sex
m ANl A~

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Acne Treatment and Prevention
CGEED GEEED GEEED GEEED
Verify ID
Identity verification
Next, let's verify your identity. This is
required by federal law to allow us to treat
you and prescribe you medication.

@ All photos are fully encrypted and
accessible only to authorized clinical
staff.

Selfie a
Take a picture of your face. This is
to verify your identity.
Take photo Upload photo
ID =
Take a picture of a government
issued ID that has your picture,
name, and date of birth. This is to
|9:41 all ¥ @
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\:C’%' Anxiety, Stress, and Depression

Medicine Refill
Refill your anxiety, stress, and depression
medication today. No insurance needed.
Start Now
Ql Acne Treatment and Prevention
(
Acne is a common skin condition that
causes blemishes. We provide prescription
strength creams and medicines to cure and
prevent it.
Start Now
E Short-Term Medicine Refill
Get a short-term (30 or 90 day supply
depending on the medicine) refill of the
medicines you take regularly.
Start Now
*Care visit prices for Gold Members are just
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|9:41 all F @)
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< Intake Interview
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Visit costs
GoodRx Gold medical visit $19
An experienced healthcare provider will
evaluate your condition and discuss
treatment options at an exclusive member
rate.
Amount due $19.00
You might see a hold but won’t be charged until
your medical visit is complete.
Payment method
Payment information is protected and
encrypted.
Confirm and pay $19.00
|9:41 all ¥ @
Acne Treatment and Prevention X
@ All photos are fully encrypted and
accessible only to authorized clinical
staff.
Selfie
Take a picture of your face. This is
to verify your identity.
Retake photo Upload photo
@ Uploaded
ID =
Take a picture of a government
issued ID that has your picture,
name, and date of birth. This is to
verify your identity.
Take photo Upload photo
|"GoodRx" Would Like to
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Access to your camera is required in
order to take picture.
PHOTO
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|9:41 all F @)
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Acne Treatment and Prevention
CGEEED CGEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 5 of 7
What other medications or
treatments have you tried?
This helps make sure we don't recommend
anything that didn't work for you before.
Benzoyl peroxide or ProActiv
(] Differin or adapalene
(] Oral antibiotics (doxycycline,
Bactrim)
|9:41 -Ill ? @'

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picture of your health so that we can give
you the best care. Add your medical history
here.
Medical conditions + Add
None Added
Surgeries or hospitalizations + Add
Nasal Fracture Reduction Remove v
Closed Reduction of Nasal

Remove v

Fracture
Medications + Add
None Added

Please message us to correct any of the

above information.
|. E—~
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Acne Treatment and Prevention
CGEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 3 of 7
What acne symptoms have you had
recently?
(] Blackheads
(] Broken or spidery blood vessels
(] Bumps after shaving
[j Deep, large, or painful pimples
|9:41 -Ill ? @'
Acne Treatment and Prevention X
Left face
Please take a close up picture of
the left side of your face.
Retake photo Upload photo
@ Uploaded
Right face
Please take a close up picture of
the right side of your face.
Retake photo Upload photo
@ Uploaded
@ Optional
Upper area of shoulders a
Please take a picture of the top
area of your shoulders.
Take photo Upload photo
|9:41 all ¥ @m)
Acne Treatment and Prevention X
you the best care. Add your medical history
here.
Medical conditions + Add
None Added
Surgeries or hospitalizations + Add
None Added
Medications + Add
None Added
Allergies or reactions + Add
None Added
No medical history
Please message us to correct any of the
above information.
|9:41 -Ill ? @'
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Acne Treatment and Prevention
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& Atorvastatin
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|12:00 P41

& Side Effects (Rare and Common)
Other side effects not listed may also occur in
some patients. If you notice any other effects,
check with your healthcare professional.
Call your doctor for medical advice about side
effects. You may report side effects to the FDA
at 1-800-FDA-1088.
The information contained in the Truven Health
Micromedex products as delivered by GoodRx is intended
as an educational aid only. It is not intended as medical
advice for individual conditions or treatment. It is not a
substitute for a medical exam, nor does it replace the need
for services provided by medical professionals. Talk to your
doctor, nurse or pharmacist before taking any prescription
or over the counter drugs (including any herbal medicines
or supplements) or following any treatment or regimen.
Only your doctor, nurse, or pharmacist can provide you with
advice on what is safe and effective for you.
The use of the Truven Health products is at your sole risk.
These products are provided "AS IS" and "as available" for
use, without warranties of any kind, either express or
implied. Truven Health and GoodRx make no representation
or warranty as to the accuracy, reliability, timeliness,
usefulness or completeness of any of the information
contained in the products. Additionally, TRUVEN HEALTH
MAKES NO REPRESENTATION OR WARRANTIES ASTO
THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY
ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF
THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL
IMPLIED WARRANTIES OF MERCHANTABILITY AND
FITNESS FOR A PARTICULAR PURPOSE OR USE ARE
HEREBY EXCLUDED. Truven Health does not assume any
responsibility or risk for your use of the Truven Health
products.

S —
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& Atorvastatin
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& Atorvastatin
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Drug info
Overview >
Proper Use >
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& Atorvastatin
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Latest news
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You’re Pregnant
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Drug info
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Side Effects (Rare and
Common)

Along with its needed effects, a medicine may
cause some unwanted effects. Although not all
of these side effects may occur, if they do occur
they may need medical attention.
Check with your doctor immediately if any of
the following side effects occur:
Less common or rare
Cough
difficulty with swallowing
dizziness
fast heartbeat
fever
hives, itching, skin rash
muscle cramps, pain, stiffness, swelling, or
weakness
puffiness or swelling of the eyelids or around the
eyes, face, lips, or tongue
tightness in the chest
unusual tiredness or weakness

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Messages X
GoodRx Care Medical Team,
July 21st, 2:16 pm
July 21st, 2:55 pm
Hello, our medical team may
be able to assist with your
needs as long as it's within
one of the specific
categories found here. You
will need to select a service
and complete a visit before a
provider would be able to
reach out.
If you do not find what you're
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GoodRx Care Medical Team,
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When you complete your
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GOLD CARD
Hello, John
Medicine cabinet Add ®
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Next pickup: Fri, Aug 18
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X
MM/DD/YYYY
02/18/1995 v
Biological sex
@ Male
O Female
Current address
This helps us connect you with a local provider.
Address line 1
1226 University Drive
Address line 2
City
Menlo Park
State
California v
Zip code
94025
Start visit
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|12:00 P41
Acne Treatment and Prevention
#V-UBTVBN4YGX
Visit status
Ready for provider, 07/24/2023
Your visit is now being processed and we'll
notify you when the doctor has reviewed it.
Check your messages in case our clinical team
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Visit costs
Total $19
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|12:00 P41l
Acne Treatment and Prevention
@ All photos are fully encrypted and
accessible only to authorized clinical
staff.
Selfie a
Take a picture of your face. This is to
verify your identity.
Take photo Upload photo
ID =
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issued ID that has your picture,
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X
Acne Treatment and Prevention
CGD GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 1 of 7
After answering a few short questions,
our medical team will be able to help
you get the care you need for your
acne. However, please know that we
are unable to prescribe the severe
ache medication isotretinoin (also
known as Accutane, Zenatane,
Absorica, Myorisan, Claravis, or
Amnesteem)
C] | understand.
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|12:00 P41
X
(_) Change to a different treatment plan
@ Other
What goals are most important to
you?
(] Works fast
Affordable or low cost
Prefer topical only
(] Prevent future acne
(] Less wrinkles and fine lines
(] Something else
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|12:00 P41
X
Let’s get started
Before your visit, please complete
your patient profile.
Patient info
Date of birth
MM/DD/YYYY
Biological sex
O Male
O Female
S —
|12:00 P41
Acne Treatment and Prevention
@ All photos are fully encrypted and
accessible only to authorized clinical
staff.
Selfie
Take a picture of your face. This is to
verify your identity.
Retake photo Upload photo
@ Uploaded
ID =
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verify your identity.
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Acne Treatment and Prevention
Your visit is now being processed and we'll
notify you when the doctor has reviewed it.
Check your messages in case our clinical team
has any follow up questions.
Visit costs
Total $19
Photos
Notifications
Text notifications Off
Need help? =
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Acne Treatment and Prevention
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Medical History
< Photos
Medical history
It's important that we have a complete picture
of your health so that we can give you the best
care. Add your medical history here.
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None Added
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No medical history
Please message us to correct any of the above
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Alabama O
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California O
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Florida O

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|12:00 P4l
Acne Treatment and Prevention

GoodRx Gold medical visit $19
An experienced healthcare provider will
evaluate your condition and discuss treatment
options at an exclusive member rate.
Amount due $19.00
You might see a hold but won’t be charged until your
medical visit is complete.
Payment method
Payment information is protected and
encrypted.

00002970
@ VISA _

Expires 01/24
O New credit/debit card
By clicking ‘Confirm and pay $19.00’ below, you
understand and agree to the Agreement for Self-
Payment of Services and shall pay these charges in
full as a self-pay patient electing not to use an
insurance policy benefit. Visits are conducted by
doctors or nurse practitioners.

Confirm and pay $19.00

Q () @ ©
Search Home Care Settings
|12:00 V4l
Acne Treatment and Prevention
X
Q_ Fracture X
Elevate Skull Fracture Fragments +
Vertebral Fracture Repair +
Turbinate Fracture +
Nasal Fracture Reduction +
Closed Reduction of Nasal Fracture +
Open Reduction of Nasal Fracture +
Laryngeal Fracture Repair +
Reduction of Facial Fracture +
Q () | J ©
Search Home Care Settings
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|12:00 P41

Acne Treatment and Prevention
CGEEED GEEED GEEED GEEND GEEED

Photos

< Verify ID

Diagnostic photos

For this visit, we need a few specific photos to
help your provider accurately assess your
medical condition.

@ All photos are fully encrypted and
accessible only to authorized clinical
staff.

Left face a
Please take a close up picture of the
left side of your face.
Take photo Upload photo
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|12:00 V41
Acne Treatment and Prevention
We've sent you a code! X
We require a valid U.S. phone number in order
for us to provide you care.
Code
12345
4
Resend verification code
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Search Home Care Settings
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|12:00 P41
Acne Treatment and Prevention
—
X
Nasal Fracture Reduction X
Closed Reduction of Nasal Fracture X
Elevate Skull Fracture Fragments +
Vertebral Fracture Repair +
Turbinate Fracture +
Nasal Fracture Reduction & Added
Closed Reduction of Nasal Fracture
e
Q () @ &
Search Home Care Settings
S —
|12:00 V4l
X
MM/DD/YYYY
02/18/1995 v
Biological sex
@ Male
O Female
Current address
This helps us connect you with a local provider.
Address line 1
1226 University Drive
Address line 2
City
Menlo Park
State
California v
Start visit
S —
|12:00 P41
Acne Treatment and Prevention
@ AIl photos are Tully encrypted and
accessible only to authorized clinical
staff.
Selfie
Take a picture of your face. This is to
verify your identity.
Retake photo Upload photo
@ Uploaded
ID
Take a picture of a government
issued ID that has your picture,
name, and date of birth. This is to
verify your identity.
Retake photo Upload photo
@ Uploaded
Q () L ©
Search Home Care Settings
S —
|12:00 V41
Acne Treatment and Prevention
.
We've sent you a code! X
We require a valid U.S. phone number in order
for us to provide you care.
Resend verification code
Q A @ &
Search Home Care Settings
S —
|12:00 P41
X
Acne Treatment and Prevention
GEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 2 of 7
How can we help you today?
O Recommend an acne treatment plan for
me
O Start a specific treatment plan
O Refill my existing medication
O Change to a different treatment plan
S —
|12:00 P41
X
Acne Treatment and Prevention
o
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‘ Answer some simple medical o
questions.
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S —
|12:00 P41l
Acne Treatment and Prevention
CGEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 7 of 7
Last question! Do any of the following
currently apply to you?
Certain conditions can increase risks or change
the treatments we recommended for you.
(] Breastfeeding
(] Immune system problems
(] Pregnant
Q ( @ ©
Search Home Care Settings
|12:00 P41
Acne Treatment and Prevention
Medical conditions + Add
None Added
Surgeries or hospitalizations + Add
None Added
Medications + Add
None Added
Allergies or reactions + Add
None Added
No medical history
Please message us to correct any of the above
information.
Q () @ ©
Search Home Care Settings
S —
|12:00 P41
X
UL/ 10/ 1IIJ90
Biological sex
@ Male
O Female
Current address
This helps us connect you with a local provider.
Address line 1
1226 University Drive
Address line 2
City
Menlo Park
@ Please select a state.
Start visit
S —
|12:00 P41
Acne Treatment and Prevention
Q () @ &
Search Home Care Settings
|© @
|12:00 P41
X
O Refill my existing medication
O Change to a different treatment plan
What goals are most important to
you?
(] Works fast
(] Affordable or low cost
(] Prefer topical only
(] Less wrinkles and fine lines
S —
|12:00 P41
é M MESSAGES
Q Acne Treatment and Prevention
Acne is a common skin condition that causes
blemishes. We provide prescription strength
creams and medicines to cure and prevent it.
Start Now
E Short-Term Medicine Refill
Get a short-term (30 or 90 day supply
depending on the medicine) refill of the
medicines you take regularly.
Start Now
*Care visit prices for Gold Members are just
$19, competitive with most insurance copays.
Gold membership is $9.99/month.
E Anxiety, Stress, and Depression Pr... >
% Anaphylaxis Prevention (Auto-inje... >
Q () e ©
Search Home Care Settings
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|12:00 P41
Acne Treatment and Prevention
—
X
Nasal Fracture Reduction X
Elevate Skull Fracture Fragments +
Vertebral Fracture Repair +
Turbinate Fracture +
Nasal Fracture Reduction
Closed Reduction of Nasal Fracture +
Open Reduction of Nasal Fracture +
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Q () @ &
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S —
|12:00 P41
Acne Treatment and Prevention
—_————————————
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What surgeries or
hospitalizations have you had?
List all the procedures and events and try to
estimate when they occurred.
Q () @ &
Search Home Care Settings
S —
|12:00 V4l
Acne Treatment and Prevention
Surgeries or hospitalizations + Add
Nasal Fracture Reduction Remove v
Closed Reduction of Nasal
Remove v
Fracture
Medications + Add
None Added
Allergies or reactions + Add
None Added
Please message us to correct any of the above
information.
Q () | J ©
Search Home Care Settings
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|12:00 P4l
Acne Treatment and Prevention
CGEEED GEEED GEEED GEEED
Verify ID
Identity verification
Next, let's verify your identity. This is required
by federal law to allow us to treat you and
prescribe you medication.

@ All photos are fully encrypted and
accessible only to authorized clinical
staff.

Selfie a
Take a picture of your face. This is to
verify your identity.

Take photo Upload photo
ID =
Take a picture of a government

Q () @ &
Search Home Care Settings
|12:00 P41
Acne Treatment and Prevention
GEEED GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
" A
+
S
Almost done!
We've got almost everything we need to get
you the right treatment. Just a few more
questions to go!
Q () e ©
Search Home Care Settings
|12:00 P41
X
Let’s get started
Before your visit, please complete
your patient profile.
Patient info
First name
Joshua
Last name
Smith
Phone number
(628) 267-9041
Date of birth
MM/DD/YYYY
02/18/1995 v
Biological sex
@ Male
O Female
S —
|12:00 P4l
Acne Treatment and Prevention
GoodRx Gold medical visit $19
An experienced healthcare provider will
evaluate your condition and discuss treatment
options at an exclusive member rate.
Amount due $19.00
You might see a hold but won’t be charged until your
medical visit is complete.
Payment method
Payment information is protected and
encrypted.
002970
@ VISA _
Expires 01/24
O New credit/debit card
By clicking ‘Confirm and pay $19.00’ below, you
understand and agree to the Agreement for Self-
Payment of Services and shall pay these charges in
full as a self-pay patient electing not to use an
insurance policy benefit. Visits are conducted by
doctors or nurse practitioners.
_ Submitting visit payment...
Q () @ ©
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|12:00 P41
X
Let’s get started
Before your visit, please complete
your patient profile.
Patient info
First name
Joshua
Last name
Smith
Phone number
(628) 267-9041
Date of birth
MM/DD/YYYY
02/18/1995 v
Biological sex
O Male
O Female
S —
|X
Ix 2x
|12:00 P4l
Acne Treatment and Prevention
CGEED GEND G
Payment

< Intake Interview
Billing
Visit costs
GoodRx Gold medical visit $19
An experienced healthcare provider will
evaluate your condition and discuss treatment
options at an exclusive member rate.
Amount due $19.00
You might see a hold but won’t be charged until your
medical visit is complete.
Payment method
Payment information is protected and
encrypted.
Confirm and pay $19.00
Q () @ &
Search Home Care Settings
|12:00 V4l
X
Acne Treatment and Prevention
CGD GEEED
Intake Interview
< Getting Started
Intake interview
Your answers are securely encrypted and will
only be reviewed by authorized staff.
Your health: 1 of 7
After answering a few short questions,
our medical team will be able to help
you get the care you need for your
acne. However, please know that we
are unable to prescribe the severe
ache medication isotretinoin (also
known as Accutane, Zenatane,
Absorica, Myorisan, Claravis, or
Amnesteem)
| understand.
S —
|12:00 P41
X
Confirm your location
We'll match you to a local healthcare provider
licensed in your state.
State
California M
S —


View visit receipt

screenKeywords:
12:00 P41
Acne Treatment and Prevention
#V-UBTVBN4YGX
Visit status
Ready for provider, 07/24/2023
Your visit is now being processed and we'll
notify you when the doctor has reviewed it.
Check your messages in case our clinical team
has any follow up questions.

Visit costs
Total $19
Photos
Q () @ &
Search Home Care Settings
S —
|12:00 P4l
% @ Your GoodRx Inc receipt [#1450-42... :
pay.stripe.com *
Receipt from GoodRx Inc
Receipt #1450-4203
AMOUNT PAID DATE PAID PAYMENT METHOD
$19.00 Jul 23,2023, 6:30:58 PM VISA - 2970
SUMMARY
GoodRx Care Gold - Visit #5392808 $19.00
Amount charged $19.00
If you have any questions, visit our support site at
https://support.goodrx.com/hc/en-
us/categories/115000937903-GoodRx-Gold or
contact us at care-support@goodrx.com.


Store detail

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12:00 V41
Safeway @
Pharmacy #2719
525 El Camino Real
Menlo Park, CA 94025
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(650) 847-2905
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Mon - Fri 9:00am - 9:00pm
Sat 9:00am - 7:00pm
Sun 10:00am - 6:00pm
Store offers
Safeway offers online refills as well as flu shots and
|12:00 V4l
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Are you a pharmacist?
Call 1-855-452-3180
Frequently asked questions >
!‘ Need help? Call (855) 487-0694
7PM-10AM GMT+08:00, 7 days a week
S —
|12:00 V41
Safeway @
Pharmacy #2719
525 El Camino Real
Menlo Park, CA 94025
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(650) 847-2905
Get directions
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Cancelling my Gold plan

screenPatterns: Confirmation Cancel

screenPatterns:
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Cancel

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Are you sure you want to cancel
your Gold Individual plan?

You'll miss out on the additional savings
of GoodRx Gold, including free home
delivery on eligible medications and up to
90% discounts on prescriptions.

NEVER MIND CONFIRM
|12:00 4l
X
Manage your Gold plan
© Your GoodRx Gold membership
has been cancelled. Your Individual
plan member benefits will expire on
August 20, 2023.
Your current plan
Individual
Monthly plan Cancelled
Member information
John Smith Primary >
Mailing address
1226 University Drive N
Menlo Park, CA 94025
Payment method
. Visa eeee 2970 5
S —_—
|12:00 4l
X
Manage your Gold plan
Your current plan
Next billing date: August 22, 2023
Individual
$9.99/mo Change >
Cancel my GoodRx Gold membership
Member information
Joshua Smith Primary >
Mailing address
1226 University Drive 5
Menlo Park, CA 94025
Payment method
— Visa eeee 2970 >
S —_—
|12:00 P41
X
Manage your Gold plan
© Your GoodRx Gold membership
has been cancelled. Your Individual
plan member benefits will expire on
August 20, 2023.
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Ordering medication

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screenElements:
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screenPatterns:
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Acknowledgement & Success

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screenElements:
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screenKeywords:
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Where do you fill this
prescription now?
We'll contact the pharmacy for you and
transfer the prescription.
Pharmacy name (CVS, Vons, etc)
Pharmacy phone number
Need help? (855)_846-4665
|9:41 all F @)
Gold Home Delivery X
-/ 1INV
Do you take any other medications?
@ Yes
Lyrica, insulin, vitamin D, etc
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Do you have any medical conditions?
() Yes
@ No
What is your biological sex?
@ Male
Q Female
Need help? (855) 846-4665
|9:41 -Ill ? @'
GOLD CARD
Hello, John
Medicine cabinet Add ®
©® DAILY MED REMINDERS
; >
You’re all caught up
< . Escitalopram 10mg
" Refillreminder 1) On
Next pickup: Fri, Aug 18
See Gold Prices
@ Escitalopram 5mg
Order #677838 >
Estimated arrival Jul 26-29
Q (2 - @ ©
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|9:41 all ¥ @
Gold Home Delivery X
|__J I'would like to speak to a pharmacist
about this order.
D Text me order updates and refill
reminders
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STOP to opt out. Consent is not required to
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Shipping address Edit
1226 University Drive
Menlo Park, CA 94025
Payment method on file Edit
m Visa ****2970
—— 1/2024
You will not be charged until your prescription is
confirmed. By completing this purchase, you agree
to the GoodRx Gold Terms and Privacy Policy.
Need help? (855) 846-4665
|9:41 -Ill ? @'
X
Confirm and pay
Patient name: John Smith
Fulfilled by Truepill
My order
0 Escitalopram $6.60
omg, 30 tablets
USPS First-Class Mail FREE
Estimated arrival Jul 26—
29
Total $6.60
Auto-refill
(] Deliver and charge me for refills
automatically
If your prescription is eligible for auto-refills,
we'll charge the card we have on file prior to
your refill on a recurring basis. The drug price
may change between refills, and isn't included
in your Gold membership fee. You can cancel
any time on your prescription page.
Need help? (855) 846-4665
|Edit prescription X
Medication options
Form
Dosage
Quantity
30 tablets N
v 45 tablets N
§ Jantities
¢ 60 tablets
90 tablets
[ 180 tablets m
|9:41 il F ()
X
Do you have an existing
prescription for Escitalopram?
@ VYes
() No
Q | don’t know
Need help? (855).846-4665
|9:41 -Ill ? @'
Gold Home Delivery X
How can we reach you?
Mobile Phone Number
(628) 267-9041
(] I'would like to speak to a pharmacist
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1226 University Drive
Menlo Park, CA 94025
Payment method on file Edit
= Visa *¥***2970
Need help? (855) 846-4665
|Edit prescription X
Medication options

Escitalopram (generic) v
Form

tablet v
Dosage
Quantity

45 tablets v
Some medications, dosages, and/or quantities
aren’t available for home delivery.

Never mind Update price
|9:41 all ¥ @m)
Gold Home Delivery X
Do you take any other medications? |
@Yes
Lyrica, insulin, vitamin D, etc
Lipitor
() No
Do you have any medical conditions?
QYes
() No
Done
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9
|9:41 all ¥ @
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form, dosage, and quantity
This information is usually on the bottle. It
has to be an exact match or the order might
not go through.
@ Why is this necessary?
Escitalopram
Form: Tablet Edit
Dosage: 5mg
Quantity: 30 tablets
Prescribed to: John Smith
Need help? (855)_846-4665
|9:41 all F @)
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Menlo Park

Zip code

94025
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|9:41 all F @)
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We care about you and want to avoid any
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O Yes
() No
Do you take any other medications?
O Yes
() No
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O Yes
() No
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|9:41 il T ()
Escitalopram
< 45 tablets 10mg . S ED)
Target (CVS)
0.2 miles
Gold Home Delivery
Free shipping
Walgreens Coupon $90
1.8 miles $48.85
P Stop n Shop Coupon $+7
2.6 miles $11.37
Duane Reade Coupon $89
0.1 miles $48.85
Community, a Coupon $89
camey - Walgreens Pharmac
9 4 $48.85
5.0 miles
Walgreens Specialty Coupon $89
Pharmac
@ macy $48.85
2.2 miles
Walmart Discount $7Z
. 5.8 miles $14.89
Q () @ @ ©
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|9:41 all ¥ @
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Menlo Park, CA 94025
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= \Jiga *¥*¥*¥*9Q97()
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|9:41 all F @)
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Just a few safety questions
We care about you and want to avoid any
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O Yes
@ No
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O Yes
() No
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O Yes
() No
Need help? (855) 846-4665
|9:41 il F ()
X
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prescription for Escitalopram?
() Yes
() No
Q | don’t know
Need help? (855).846-4665
|9:41 -Ill ? @'
X
Order received!
Our fulfillment partner will begin preparing
your shipment of Escitalopram (5mg, 30
tablets) as soon as your prescription transfer
is verified.
Order #677838
Estimated arrival Jul 26-29
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@® *
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|9:41 oll ¥ @
X
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prescription
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only take a few business days.
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Medication options
Escitalopram (generic) v
Form
tablet v
Dosage
10mg v
( 5mg
[ v 10mg N,
20mg
S ) . . ,uantities
aren’t available for home delivery.
Never mind Update price
|9:41 all ¥ @
X
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just have your prescription information ready
and we'll get started immediately.
Expect your medication to arrive to your
doorstep within 4-7 business days via USPS.
Frequently asked questions
@ You have successfully updated your
order
My order Edit
0 Escitalopram $6.60
omg, 30 tablets
USPS First-Class Mail FREE
Estimated arrival Jul 26-29
Need help? (855) 846-4665
|Edit prescription X
Medication options

Escitalopram (generic) v
Form

tablet v
Dosage
Quantity

45 tablets v
Some medications, dosages, and/or quantities
aren’t available for home delivery.

Never mind Update price
|Escitalopram 5mg @
Retrieving prescription info
Current order
Order #677838 S
Estimated arrival Jul 25-28
v Order received
‘. Retrieving your prescription
This typically takes 3-6 days. We'll update
you on our progress.
Preparing shipment
In transit
Delivered
“ Need Help? Call (855) 846-4665
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|9:41 all F @)
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|9:41 oll ¥ @
X
We’'ll transfer your
prescription
As long as everything looks good this should
only take a few business days.
(@ How do transfers work?
Pharmacy transfer
@ We'll contact your pharmacy to transfer
your prescription
Doctor transfer
Q We'll contact your doctor’s office to
transfer your prescription
Need help? (855) 846-4665
|9:41 all F @)
X
Just a few safety questions
We care about you and want to avoid any
issues with your prescription.
Do you have any allergies?
O Yes
@ No
Do you take any other medications?
@ Yes
Lyrica, insulin, vitamin D, etc
() No
Do you have any medical conditions?
O Yes
Need help? (855) 846-4665
|9:41 all F @)
X

Where do you fill this
prescription now?
We'll contact the pharmacy for you and
transfer the prescription.

Pharmacy name (CVS, Vons, etc)

Safeway

Pharmacy phone number

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|9:41 all ¥ @
X
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Expect your medication to arrive to your
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Frequently asked questions
My order Edit
0 Escitalopram $13.05
10mg, 45 tablets
USPS First-Class Mail FREE
Estimated arrival Jul 26-29
Need help? (855) 846-4665
|Edit prescription X
Medication options

Escitalopram (generic) v
Form

tablet v
Dosage
Quantity

30 tablets v
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GoodRx Price: $4.46
° Escitalopram 10mg soe
GoodRx Price: $3.75
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GoodRx Price: $96.99
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Menlo Park 94025
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Visa eeee 2970
VISA >

1/2024
|X
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Menlo Park 94025
|X
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() Billed annually Save 25%
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1 member Current
@ Family $19.99
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«»
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& GoodRx Gold
Safeway
NEAREST SAFEWAY
525 El Camino Real
Closed until 9:00 am
Call pharmacy
(650) 847-2905
Get directions
1.2 miles
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|Atorvastatin
40mg 30 tablets
You’re saving 97% with Gold
$4.46
Retail price: $15777
Joshua Smith
BIN 015995
PCN GDC @
Group GOLD
Member ID AF352702
GoodRx Gold +;
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This is not insurance
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|12:00 V41

Atorvastatin
40mg 30 tablet

@ Safeway

Current Gold price $4.46

Retail $15777
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Medicine cabinet
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GoodRx Price: $4.46
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GoodRx Price: $3.75
° Lexapro 5mg
GoodRx Price: $96.99
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(0OV) 84 7-2900 U
Get directions
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Cold Symptoms
Cold symptoms are part of the common cold.
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Drug Types
Antihistamine / Non-narcotic Antitussive
Combinations >
13 Drugs
Antihistamine / Alpha Agonist /
Non-narcotic Antitussive Combinations >
15 Drugs
Opioid / Phenothiazine Combinations 5
1Drugs
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24 Drugs
Antihistamine / Opioid Combinations N
9 Drugs
Antihistamine / Alpha Agonist
Combinations >
19 Drugs
|12:00 P41
& Cold Symptoms
2 Drugs
Expectorant / Opioid / Sudafed
Combinations >
1Drugs
Non-narcotic Antitussives 5
7 Drugs
Expectorant / Opioid Combinations N
4 Drugs
Local Anesthetics 5
50 Drugs
Acetaminophen Combinations 5
28 Drugs
NSAID Cough and Cold Combinations N
8 Drugs
Opioid / Sudafed Combinations N
1Drugs
Expectorant / Alpha Agonist Combinations 5
3 Drugs
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m Lexanro (Escitalonram) >
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Hello, Joshua
Medicine cabinet
° Atorvastatin 40mg oo
GoodRx Price: $4.46
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° Lexapro 5mg
GoodRx Price: $96.99
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> am > O
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cold X CANCEL
Drugs
colchicine
colestipol (generic Colestid)
colesevelam (generic Welchol)
Colcrys (colchicine)
Coly-Mycin S
Health conditions
Cold Symptoms
Bacterial Infection
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COPD
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|12:00 V41
Configure prescription
Ibuprofen / pseudoephedrine o«
Generic Advil Cold and Sinus
Form
Tablet M
Dosage
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NSAID Cough and Cold
Combinations
NSAIDs (Non-steroidal anti-inflammatory
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ingredients like diphenhydramine (Benadryl),
and dextromethorphan to relieve cough, cold,
allergy, and insomnia symptoms along with
treating pain and fever.

@ Featuring GoodRx Fair Price

Most popular drugs

= Advil Cold and Sinus (ibuprofen / $10

= pseudoephedrine)

_ Advil Allergy Sinus $14

~ Advil Allergy and Congestion $18

_Advil Congestion N/A

_ AdVvil PM (ibuprofen PM) N/A

_ Motrin PM (ibuprofen PM) N/A
Sudafed Pressure and Pain N/A

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|12:00 P41
& NSAID Cough and Cold Combina...
medications) are combined with other active
ingredients like diphenhydramine (Benadryl),
and dextromethorphan to relieve cough, cold,
allergy, and insomnia symptoms along with
treating pain and fever.
@ Featuring GoodRx Fair Price
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= Advil Cold and Sinus (ibuprofen / $10
= pseudoephedrine)
_ Advil Allergy Sinus $14
_Advil Allergy and Congestion $18
_Advil Congestion N/A
_ AdVvil PM (ibuprofen PM) N/A
_ Motrin PM (ibuprofen PM) N/A
_ Sudafed Pressure and Pain N/A
aspirin / chlorpheniramine /
. $6
= phenylephrine
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Escitalopram c
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BIN 015995
PCN GDC i
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Escitalopram
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@ How to use this coupon
%, Need help? Call (855) 272-8070
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& Atorvastatin
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©Q San Francisco, CA Popular v
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Q Menlo Park,CA
Zolpidem (generic Ambien) Edit
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Safeway retail price $68.70 Save 95%
o CVS Pharmacy $8.45
. >
0.95 mi Save 87%
@ Target (CVS) $8.45
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& 235mi Save 87%
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|9:41 all T @)
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Q Menlo Park,CA
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325 Sharon Park Dr N
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Stanford Health Care Pharmacy
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45 tablets 10mg
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Retail price: $193.55
John Smith
BIN 015995
PCN GDC .
Group GOLD
Member ID AF346245
(CToTelo |20 {Elolle)
Show your Gold card information above to
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NEAREST SHOPRITE
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Open until 7:30 PM
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1/2024
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You’re all caught up
< . Escitalopram 10mg
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015995

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