One More Step – Medical History

Thanks for purchasing our Go Pack! There is one more step before we can finalize your order!  Once the below is completed, our doctors will review the information to ensure you are a good candidate for the medicines and reach out to you via the email address on file.

Note – This form is unique to you and will expire shortly. If you do not submit a medical history, your order cannot be processed. If you experience any issues submitting, please contact us asap at support@contingencymedical.com