Simply contact us to get started and we will mail you your personalised sleek platenium LifeCard. The LifeCard is more thenjust a card, its the key to your sexual health and STD prevention!
LifecardTM Consultation
The consultation fee is to get you a visit with one of our physicians! If you decide the Lifecard is right for you, the $49 will go towards your yearly membership fee. Simply complete the form below and we will contact you promptly to schedule an appointment.
*First Name
*Last Name
*Name on card
*Payment Amount $
*Card Type :
*Card Number:
  Number only. no spaces or dashes
*Security Code: (last 3 or 4 digit # on back of card)
  *Card Expiration Date (MM/YYYY)

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