First decision...
How do you like your forms?
Switch anytime. Your answers stay put.
Part 1 of 5
The deets.
The boring-but-required stuff. My prescription software won't take no for an answer.
1
First, a photo of you.
So I can put a name with a face, and know exactly who I'm prescribing to. A selfie is perfect. It's just for me, never shared or posted.
2
What's your name?
As it shows on your ID. (It goes on your prescriptions.)
3
When's your birthday?
Just type the numbers. The slashes fill in.
Month · Day · 4-digit year (like 08/02/1979)
4
Best email?
For receipts and the occasional No BS Brief. Never spam.
5
Where do you live?
Street, city, state and ZIP: all four. Your phone may offer to fill it in for you.
Part 2 of 5
Now, the health stuff.
Write it like you'd text me. A word or a whole story.
6
Your medical history & health concerns.
Anything I should know. Diagnoses, surgeries, what's bugging you. Type None if there's nothing.
7
What are you hoping I can help with?
A specific prescription or treatment, or “not sure, let's figure it out.” Both are perfect.
Part 3 of 5
Meds, allergies & your pharmacy.
The safety check. Every box needs an answer, even if it's None.
8
Current medications?
Everything: prescriptions, supplements, over-the-counter. Name and dose if you know it.
9
Any allergies?
Medicines, foods, latex, anything. Add what happens if you know. Or tap None.
10
Which pharmacy?
Search by name and ZIP and tap yours. The ZIP is a must: it's how I find it in my system.
11
Use a second pharmacy?
Lots of my patients do: one for compounded meds (like Trinova Health) and one for everyday stuff. Add it once and it's on file. No more me asking twice.
Part 4 of 5
Your numbers.
No judgment. Ballpark is fine.
12
Height, weight, heart rate & blood pressure.
Recent or average is fine.
Height
Weight (recent)
lb
Heart rate
bpm
💓 Tip: two fingers on your wrist or neck, count the beats for 60 seconds. (Or 15 seconds × 4.)
Blood pressure (average)
/
🩺 No cuff? Most grocery stores and drugstores have a free machine, or grab one for home for about $15.
Part 5 of 5
Almost done.
Last few. Then you're in.
13
Any other questions or concerns?
A whole story or just “nope.” Both count.
14
Text or call?
Texting is fastest. I answer between patients.
15
Who sent you my way?
Name names! I like to thank people.
16
One more for the testers.
You're helping me build this.
17
Last thing. The fine print.
Plain English, I promise.