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Empowering You to Make Your Decision

Contact Form Demo (#5)

What to expect

  • Provide medical history and contact information.
  • Upon medical approval, you will cover the cost of your medication abortion pills along with shipping. Our physician will then submit your prescription to our partnered pharmacy for fulfillment.
  • If financial hardship prevents you from affording your abortion pills, please submit this form, and we will reach out to finalize your registration for financial assistance. Otherwise, proceed with your intake now, paying $289 plus shipping for your consultation and abortion pills. We also provide a buy now, pay later option through PayPal, allowing you to make monthly payments. Further details are available at checkout.
  • Your abortion pills will be delivered in a discreet, unmarked package within 72 hours, accompanied by comprehensive instructions for their use.
  • Our team will be accessible to you around the clock, 24/7, to address any questions or concerns throughout your journey, ensuring you feel confident when using these medications at home. Feel free to contact us at 000-000-0000 for any support inquiries.

In order to complete this process, you'll need to have

    • Photographs of your identification (Driver's license, state-issued ID card, passport) are required. Any ID with your name, date of birth, and photo is acceptable. Your ID does not necessarily have to be issued in Massachusetts or New Hampshire, but your pills must be shipped to an address within Massachusetts or New Hampshire to be eligible.
    • Total payment amount of $289, plus shipping costs.

You'll begin by providing basic demographic details, followed by answering medical history inquiries, and finally completing the payment to submit your request for review.

Consent to Telemedicine

Telehealth encompasses the utilization of live audio-video or other forms of synchronous and asynchronous electronic communications to provide healthcare services to patients, with the healthcare provider (Provider) situated at a physical location distinct from the patient receiving the healthcare services (Telehealth Services).

By consenting to receive Telehealth Services from Paragon Life Care via all websites provided by ("Paragon Life Care", "we", "us" or "our"), including the Site hosted on the domain [https://paragonlifecare.com/] (collectively, "Sites"), and all services provided by us in connection with such Sites or otherwise (Paragon Life Care),

  1. There are potential risks associated with using electronic communications for healthcare visits, including service interruptions, unauthorized access, technical difficulties, call termination, or equipment failures. I acknowledge and accept these risks, understanding that alternatives to Telehealth Services are available.
  2. I understand that protected health information will be transmitted via email or SMS text messaging. I am aware that messages shared through these channels may not always be secure.
  3. Either I or the Provider can discontinue Telehealth Services if we determine they are not suitable for my healthcare needs.
  4. It is my responsibility to provide accurate, complete, and current information about myself and my health conditions to the Provider during Telehealth Services.
  5. The Practice has made reasonable efforts to address confidentiality risks associated with Telehealth Services. I am also responsible for minimizing any privacy risks related to my participation in Telehealth Services (e.g., ensuring privacy during the encounter).
  6. I understand that Telehealth Services are not intended for emergencies. In case of an emergency, I should not rely on Telehealth Services and should instead call 911 or visit an emergency department.
  7. I acknowledge that I understand the implications of receiving Telehealth Services and am legally authorized to consent to their use.
  8. I am responsible for any charges incurred from my mobile or internet service provider while receiving Telehealth Services.

By continuing, I, the patient, hereby:

I confirm that I have read and comprehended this Consent to use Telehealth Services and the expected benefits and risks associated with the utilization of telehealth provided to me through the paragon life care for Application. I hereby provide consent to receive Telehealth Services from providers engaged through the paragon life care for Application.

PATIENT AGREEMENT FORM

Mifepristone Tablets, 200 mg

Response: paragon life care will not be able to proceed with processing your request for medication abortion at this time. In the event you have any questions regarding your intake results please feel free to contact us at info@paragonlifecare.com

Our Experts

Our Doctors & Medical Specialists

Our doctors and experts are very sincere and professional in handling your every problem, armed with qualified experience in their fields.

About Us

Empowering You to Make Your Decision

Our doctors and experts are very sincere and professional in handling your every problem, armed with qualified experience in their fields.

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