CHOOSE A MEMBERSHIP PLAN

STEP #1: Select A Plan

Item	Price
Month to Month	$299.00
Annual Primal Plan	$1497.00
Month to Month - 5% Off First Payment	$284
Annual Primal Plan - 5% Off First Payment	$1422
Month to Month - 10% Off First Payment	$269
Annual Primal Plan - 10% Off First Payment	$1347
Month to Month - 15% Off First Payment	$254
Annual Primal Plan - 15% Off First Payment	$1272
Month to Month - 20% Off First Payment	$239
Annual Primal Plan - 20% Off First Payment	$1197

Enter Your Promo Code Below (If you have one)

STEP #2: Contact Information

STEP #3: Billing Address

STEP #4: Payment Information

Credit Card Number:

CVC Code:

Expiry Month:

Expiry Year:

STEP #4: Payment Authorization

By Checking this box I authorize a (1) one time charge of the amount below to the credit card listed in this authorization form. The payment authorization is for the service of a non-refundable telemedicine membership with a licensed doctor in your state. Your doctor consultations may be reimbursable with your insurance provider. I certify that I’m an authorized user of this card and will not dispute this payment with my card company, so long as the transaction corresponds to the terms and conditions.

Patient Authorizes

Item	Amount
Dynamically Updated	$XX.00

Complete Order

SOME GREAT PERKS
OF MEMBERSHIP

Start-Up Lab Test - Full Panel Blood Diagnostic

Initial & 30 Day Follow-Up Consultations with Doctor

Quarterly Review Doctor Consultations & Lab Testing

Wholesale Pharmacy - Full Access for all Meds! Home Delivery & 20% to 60% SAVINGS!

SERVICES AT
PRIMAL MEDICAL

Performance Primary Care

Nutritional Consultation & Planning

Diagnostics & Preventive Screening

Hormone Optimization (Male and female)

Anti-Aging Therapy

Medical Weight-Loss

Performance Medicine

Enter Your Promo Code Below (If you have one)

SOME GREAT PERKS OF MEMBERSHIP

SERVICES ATPRIMAL MEDICAL

Working...

SOME GREAT PERKS
OF MEMBERSHIP

SERVICES AT
PRIMAL MEDICAL