Top Health Center

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One Time Consulting Charges: $49.99 (USD)

The above payment is for consultation only and does not cover the cost of your medication. Top Health Center will only send your prescription to your pharmacy of choice.

1 - Which of the following symptoms do you suffer from?*

2 - What triggers your symptoms?*

3 - Please rate the severity of your symptoms.*

4 - Approximately when did your symptoms start? *

5 - Which of the following apply to you?*

6 - Which of the following apply to you?*

7 - If you've taken medications in the past, were they effective?

8 - Have you had nasal surgery (including sinus surgery, septoplasty, rhinoplasty, polyp surgery, turbinate surgery) in the past 3 months?*

9 - Have you been diagnosed with allergic rhinitis or seasonal/environmental allergies by a healthcare provider?*

10 - Do you have or have you ever been diagnosed with any of the following?*

11 - Do you have any of the following conditions?*

12 - Do any of these apply to you?*

13 - Do you have a history any psychiatric disease? *

14 - Please list any additional medical conditions, surgeries, or hospitalizations you have had.

15 - Are you currently breastfeeding, currently pregnant, or may become pregnant?*

16 - Do you take any medicines, vitamins, or supplements?*

17 - "Are you allergic to any of the following medications? "*

18 - Please list any additional allergies you have.

19 - Do you have a preference on medication type? *

20 - Do you have a preferred treatment? *

21 - Please enter preferred pharmacy information.*

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