Prescribe-Rx - Registration

Patient Intake Form

Complete your telehealth consultation intake

Appointment with Mrs. Leslie Johnson, NP,

Personal Info

Address

Medical History

Insurance & Consent

Verification

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

PRX Tech LLC Text Message (SMS) Program

PRX Tech LLC may send you SMS/MMS messages at the mobile number you verified during registration. Message types include: appointment reminders, telehealth video consultation join links, prescription and pharmacy status notifications, password reset and account security alerts, and other transactional notifications related to your care and platform account.

Message frequency varies based on your activity and treatment schedule. Message and data rates may apply.

You can manage SMS preferences at any time from your account notification settings, or reply STOP to any message to opt out. Reply HELP for assistance. Contact us at compliance@prescribe-rx.com or (678) 324-4763.

Consent to receive SMS is not required to use PRX Tech LLC or receive healthcare services. You may use the platform and receive notifications by email or in-app only.

Terms & Conditions · Privacy Policy

I consent to receive SMS/MMS messages from PRX Tech LLC (PRX Tech LLC) at my verified mobile number for the message types described above.

You can change this preference at any time in your notification settings.

Date of Birth *

Gender *