Regarding COVID-19
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Have you tested positive for COVID-19?
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If yes, please provide the exact date of your positive test.
Have you had COVID-19 prior to right now?
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Have you been vaccinated for COVID-19?
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If yes, please add the date each dose was administered.
Is there any chance that you might be pregnant?
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Have you been in close contact with a person who tested positive for COVID-19?
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If yes, what is your relationship to that person (husband, coworker, stranger, etc.)?
How are you feeling?
Do you have any symptoms related to COVID-19?
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If yes, when did your symptoms start?
Please select all the symptoms you have experienced.
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Let's find the right treatment for you
Do you take any of the following medications?
Have you been diagnosed with the following conditions ?
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Would you like to share anything else with your provider through an upload?
