Complete your secure evaluation in less than 2 minutes and receive a personalized treatment plan tailored to your needs.
Submission of this form confirms your request for payment by credit card. You agree to pay any and all amounts charged by U Benefit Now to your credit card as specified below. In addition, you authorize U Benefit Now to obtain approval from the credit card company listed below and to charge your credit card account accordingly.
I confirm that I am at least 18 years old and legally authorized to use the credit card account listed below. I understand and agree that all charges made to this account are non-refundable and I agree to pay in accordance with my agreement with the specified credit card provider for all amounts charged, both past and future.
Furthermore, I agree to hold U Benefit Now completely harmless from and against any and all claims of any type or nature resulting from charges made to the account listed below. I understand that payments will be processed using the credit card provided and that compounded medications may be charged in advance of preparation.