International Medication Enrollment
$15 per person per year membership

Once we receive this form and the $15 yearly processing fee, you will receive your international AIDS medication ordering packet by return mail.  Simply sign the forms in the packet and return by fax or mail with a copy of your prescriptions.

Immediate Coverage ... When you need your AIDS medications soon, please call our office during regular business hours (M-Fri 8 a.m. - 4 :30 p.m.) toll free (888) 380-6337.   Within minutes, the staff will complete your enrollment, enter your membership into the computer and start your enrollment.  Please have your credit card, a fax number and copies of your prescriptions when you call.

International AIDS Medication Information Form

Patient's Name:
Date:  Telephone #:
Street Address:
City, State, Zip:

List Names Of Needed Medications

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Your Email:

Copyright © 1998 Medical Discounts, Inc. (aka Global Health Discounts, Affordable Care Dental Plan)      All rights reserved.
Medical Discounts is not a health care provider, pharmacy or an insurance company.  A valid prescription/physician referral is required for any procedures or medications ordered. Prices may change without notice. Medical Discounts is not an insurance company.  Medical Discounts does not make any payments to healthcare providers and/or members. Participating providers are independent contractors.  Medical Discounts has NO clinical personnel.  All clinical decisions are made directly between the healthcare provider and patient.  All pricing decisions in the offices are between the healthcare provider and the patient.  Patients can agree to a price that is not listed as a contract MDI price.  Any agreed upon prices and work done does not effect the 30 day satisfaction guarantee.  The 30 day money back guarantee is for unauthorized charges over the listed fees.  Medical Discounts staff will not interfere in any financial or clinical negotiations between the provider and the patient.  Prices may vary by provider and location, but patients should be told in advance if there is a difference in price.  Prices may change without notice.  Unless otherwise stated, prices do not include travel and recuperation expenses.  Information on this website is for shopping comparison purposes only.  The clinical information is not intended to be used to help people make clinical decisions.  To get accurate clinical information, consumers are expected to speak with their dentists, physicians and other appropriate licensed health care professionals.

Last modified: September 14, 2011

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