CHECKOUT

WELCOME TO THE CJS HEALTH FAMILY

Joining our Tele-Medicine Program is easy. Please simply complete the enrollment form below, and we will get your account activated.

FULL NAME(Required)

First Last

MAILING ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

MOBILE PHONE(Required)

HOME PHONE

GENDER

BIRTHDATE

DESIRED PROGRAM(Required)

COUPON CODE

INVALID COUPON CODE. PLEASE ENTER A VALID CODE.

COUPON CODE ACCEPTED. THE TOTAL MONTHLY CHARGE WILL BE REDUCED BY 20%

PAYMENT DETAILS

PREFERRED PAYMENT METHOD(Required)

PLEASE LET US KNOW HOW YOU WOULD LIKE TO PAY FOR YOUR PROGRAM MEMBERSHIP

CARD NUMBER(Required)

EXP. MONTH(Required)

EXP. YEAR(Required)

CVV CODE(Required)

PAYPAL ID(Required)

We will send a payment request to your PAYPAL ID shortly. Please complete the payment request once you received it.

We will send an electronic invoice with a payment link to your provided email address shortly. Please complete the payment request once you received it.

We will send you a link to your email address with a link where you can complete the authorization of your membership fees.

Your Membership activation will be processed once we have received your payment.

You will received an email and a text message with usage instructions, within 24 - 48 hours of payment receipt.