Request Care in 4 Easy Steps
Pre-Authorize Payment of Virtual Consult Fees
Please complete the form below to request care from a licensed medical provider in New Hampshire. This information is used by the medical provider to review your request and provide a care recommendation.
Good news! There are providers in your state who can handle your request. We need to pre-authorize payment for an online consultation with a licensed medical provider. Based on your request and location, we need to pre-authorize payment of up to $64.99. The consultation fees for this request may cost less, but will not cost more than the pre-authorized amount. Fees related to medication(s) prescribed are separate and paid directly to your selected pharmacy when receiving the medication(s).
Please review carefully. Errors cause delays.