ChatRx is Launching Very Soon!

We Are Working Super Hard to Get our Exciting Telemedicine Product to You!

Hello there! You recently signed up for our pre-launch waitlist!

We'd like to get to know you better so we can personalize our services for you. If you could please provide the information below, we'd really appreciate it!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Your Contact Details - correct as needed

Name*

General Information (fields with * are required)

Age Range*
What age range do you fall into?
Gender*
Please select your gender

Healthcare Options (fields with * are required)

Healthcare Coverage*
Choose the option that best describes you
Care Options*
How do you typically get medical care for minor illnesses?
Access to Healthcare*
Which of these statements best describes your situation?
ChatRx Usage*
Are you primarily interested in ChatRx for:
Common Conditions*
For which conditions would you use ChatRx?
How did you hear about ChatRx? **
Please select one or more
Which devices would use to access ChatRx?
Please select one or more
How would you like to receive updates? **
Please select one, or more, or all

Optional Information

The information below is optional but will help us customize your experience even more.
Education
Please select one option
Income Bracket
Please select one option
Please enter your primary zip code