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Monthly Plan
$14.95
/mo
$
5.95
/mo
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Anytime
24/7/365
Access
$
45.00
General Medical Visit Fee
$
99
Therapy Visit Fee
$
225
/$
99
Psychiatric Initial/Follow-up Visit Fee
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Annual Savings Plan
$99.95
/yr
$
49.95
/yr
One Convenient Payment
24/7/365
Access
$
40.00
General Medical Visit Fee
$
99
Therapy Visit Fee
$
225
/$
99
Psychiatric Initial/Follow-up Visit Fee
Choose Plan
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I hereby authorize Wellspring Telehealth LLC d/b/a WellVia to debit the credit card account indicated in this web form for the noted amount on the schedule indicated. This payment is for a subscription to the WellVia service offering. I understand that returns, refunds and cancellations are to be handled in accordance to the WellVia Subscription Agreement. I also understand that this authorization will renew automatically at the conclusion of a subscription term unless I cancel it. If the above noted payment date falls on a weekend or holiday, I understand that the payment may be executed on the next business day. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this web form.
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,
WellVia Terms of Use
,
WellVia Notice of Privacy Practices
, and the
Informed Consent
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