Ear Infection Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 55Email *NextName *PhoneNextDate of Birth *Confirm Date of BirthCheck to confirm date of birthGender *MaleMaleFemaleWeight *Height *4' 0''4' 0''4' 1''4' 2''4' 3''4' 4''4' 5''4' 6''4' 7''4' 8''4' 9''4' 10''4' 11''5' 0''5' 1''5' 2''5' 3''5' 4''5' 5''5' 6''5' 7''5' 8''5' 9''5' 10''5' 11''6' 0''6' 1''6' 2''6' 3''6' 4''6' 5''6' 6''6' 7''6' 8''6' 9''6' 10''6' 11''7' 0''7' 1''7' 2''7' 3''7' 4''7' 5''7' 6''7' 7''7' 8''7' 9''7' 10''7' 11''RaceSelectAlaska NativeAmerican IndianAsianBlack/African AmericanHawaiian or Other Pacific IslanderHispanicWhiteOtherOther Race *Marital StatusSelectSingleMarriedDivorcedSeparatedPreviousNextWho is the patient? *Myself (the patient)Myself (the patient)Pediatric (2-17 yrs old)FriendPreviousNextWhat disease are you suffering from? *PreviousNextSelect Your Location *TexasTexasKansasGeorgiaFloridaNevadaMississippiLouisianaAlaskaSouth CarolinaSouth DakotaAlabamaArkansasNew MexicoLet's match you with an authorized medical professional in your state.PreviousNextConsent to use information *We kindly request your consent to use the information collected during your interactions with our platform, to ensure transparency and data protection. Visit our privacy policy for more informationPreviousNextAuthorization to administer treatment and informed consent *I thus give my consent for the medical staff at ReddyDoc to examine my medical background and provide telemedicine (synchronous or asynchronous) healthcare to me, the patient.In the event that my chosen or preferred prescription is possibly hazardous, unsafe, controlled, risky, interacts with another medication I'm taking, or has an adverse drug reaction, I thus give ReddyDoc permission to prescribe an alternate drug.According to what I've been told, telemedicine services are only appropriate for mild to moderately complex medical requirements. I am aware that ReddyDoc will refuse to treat patients with serious or complex diseases and will cancel their appointments.I am aware that, in the absence of a physical examination, ReddyDoc will deliver online medical services based on the medical history I submit. I thus accept full responsibility for any injury or losses that may result from providing false, misleading, or incomplete information.I am aware that using telemedicine has a risk of misdiagnosis because there is no physical exam or in-person evaluation.I consent to phone 911 or follow up with a doctor for an in-person assessment if my symptoms get worse or don't get better quickly.PreviousNextTerms of use *I am aware that if my medical practitioner needs more information or if I submit insufficient medical history, the process could be delayed.I am aware that the consultation charge does not cover the cost of the medicine if I decide to pick up my drug(s) from a pharmacy; I will still be responsible for paying that pharmacy.I've been told that I can use my insurance to pay for my medication at the drugstore.I understand that I must email ReddyDoc to request an alternate medication or out-of-pocket (self-pay) options if my insurer is unable to pay for the required test or medication, or if the cost of the medication is prohibitive. I've been told that insurance restrictions or prescription costs are not acceptable justifications for issuing a refund. The patient is financially accountable for their prescriptions and medical services.PreviousNextDo you have a life-threatening symptom or a medical emergency? *YesNo life-threatening symptomsWe do not, unfortunately, treat life-threatening disorders. Please call 911PreviousNextAre you focused and alert? *YesNoYou must be focused and aware.PreviousNextAre you allergic to any medications? *No, there are no medication allergies (NKDA).YesWhat drugs do you have an allergy to? *PreviousNextDo you have any underlying medical issues? *I have no chronic medical or psychiatric issuesHeart diseaseHypertensionLiver diseaseKidney diseaseDiabetesHigh cholesterolThyroid disorderPsychiatric conditionHIV/AIDSOther ConditionList any further health issues you may have. *PreviousNextType of heart issue *Coronary Artery Disease (CAD) or heart attackHeart Valve DiseaseArrhythmias or abnormal heartbeatHeart Failure or CHFCongenital Heart DiseaseCardiomyopathy (Heart Muscle Disease)Pericardial DiseaseOtherList other heart conditions that you have *PreviousNextWhat is the average reading of your blood pressure? *Normal (Less than 140/90)Elevated (Less than 160/100)Uncontrolled (Over 160/100)PreviousNextType of liver diseasePreviousNextType of kidney disease *Kidney stonePolycystic Kidney DiseaseKidney infection or cystNephritis or nephropathyKidney cancerElevated creatinine or low GFRSolitary or Single-functioning KidneyOtherList other kidney disease *PreviousNextHow stable or controlled is your diabetes? *Well controlled (Glucose below 150 or Hba1c less than 8)Somewhat controlled (Glucose below 200 or Hba1c less than 9)Uncontrolled Diabetes (Glucose over 200 or Hba1c over 9)PreviousNextLast thyroid test *Normal TSH level in the last 12 monthsElevated TSH (or low T4 or T3) levelLow TSH (or low T4 OR T3) levelNo thyroid lab test in the last 12 monthsI have symptoms of abnormal thyroid disorderPreviousNextSelect applicable psychiatric condition *DepressionAnxietyPanic disorderBipolar or mood disorderSchizophrenia or psychosisPTSDEating disorderOCDOtherList other Psychiatric condition *PreviousNextAre you currently taking any medication? *NoYesEnter medication name *PreviousNextMedication Disclosure Clause *I hereby certify that I am NOT currently taking any medication including OTC or supplements, and agree to indemnify and hold ReddyDoc and its employees harmless from any loss, damages, liability, legal liability and expenses resulting from withholding or non-disclosure of my medication or any other vital medical informationPreviousNextChoose the relevant surgical historyNo surgical historyAppendectomyImplanting breastsC-sectionSurgery to remove the gallbladderHysterectomyHernia repairMastectomyOrthopedic surgeryTonsillectomyVarious surgeriesList any more procedures you have had in the past. *PreviousNextChoose the relevant social historyNon-smokerDrink Coffee multiple times a dayCurrent smoker (Vape, cigarette or tobacco)Former cigarette or tobacco usePrescription drug addictionAlcohol addictionDrug use (cocaine, marijuana, etc.)PreviousNextWhen was your last in-person visit to the doctor? *Within the past three(3) monthsWithin the last three (3) to six (6) monthsWithin the last six (6) to twelve (12) monthsMore than a year agoNEVER met a doctor in personPreviousNextAre you the patient in need of medical treatment? *Yes, I'm the patient in need of treatmentI'm filling out this consultation on behalf of the patientSTOP! PATIENT ALONE MUST COMPLETE THIS FORMPreviousNextWhat is the main justification behind this consultation? *Pimples or rashes at the outer earVertigoEar InfectionTinnitus (ringing)Hearing lossHerpesSTOP! Unfortunately due to the limitation of telemedicine, we do not treat this condition online. See an OphthalmologistPreviousNextWhen did your signs first appear? *Less than 7 days1 - 4 weeksMore than three monthsGreater than one monthPreviousNextSpecify the affected ear. *Left earRight earBoth earsPreviousNextCheck all applicable symptoms *Ear ache or painItchiness and discomfort in the ear canalThe outer ear is swollen and red.Tugging or pulling an earFeverPimple or boil in the ear canalLoss of balanceHearing lossNone of the aforementioned symptomsSTOP: This is a sign of complicated ear disorder. Contact us at info@www.condition.reddydoc.com for help.PreviousNextDo you have an ear discharge or drainage? *Yellow/green drainageA clear or watery drainageBlood coming out of the earNoneWe advise seeing a nearby physician to have your ear(s) examined.PreviousNextDo any of these additional signs apply to you? Verify each applicable item. *Throat painCoughing up yellow or green due to a painful throatCoughing up something white or clearNasal pressure, drainage, and sinusNone of the symptoms listed abovePreviousNextDo you feel feverish? *Lower than 100.°FOver 101.°FI feel cozy.No feverPreviousNextDo any of the following describe you? I frequently have ear infections.I have just been swimming.I have had ear (tube) surgery in the past.I do not get ear infections all the time.Respiratory sickness or a recent coldPreviousNextDo you currently take any prescription or over-the-counter medications for this condition? *YesNoPreviousNextWhat prescriptions are you on? *PreviousNextHave you had ear or respiratory infections over the last six to twelve months? *YesNoPreviousNextBriefly describe your most recent medical encounter. *PreviousNextDescribe in detail any additional ear-related symptoms you may have (optional)PreviousNextWould you prefer a prescription for ear drops or an oral medication? *Ear dropsOral AntibioticBoth oral antibiotic or ear dropsI will leave that to the doctor.Other (Write in)Describe your chosen drug or therapy here, if applicable. *PreviousNextWhich drug from this list would you like us to recommend to you? *AmoxicillinAzithromycinAugmentinCefdinirI will leave that to the doctor.PreviousNextWhich ear drops from this list would you like us to recommend?Ciprodex ear drop (an expensive option)Ofloxacin ear dropsNeomycin-polymyxin-hydrocort ear dropsI'll let the doctor decidePreviousNextWhich drug from this list would you like us to recommend to you? *Ear drops plus AmoxicillinEar drops plus AzithromycinEar drops plus AugmentinEar drops plus CefdinirI'll let the doctor decidePreviousNextWould you like to provide the medical provider photographs of the afflicted area or supporting medical records?YesNoPreviousNextUpload Images and Medical recordsFile Upload Click or drag files to this area to upload. You can upload up to 3 files. PreviousNextDo you have any further details you would like to present to the doctor today? (Optional)PreviousNextGiven the limitation of telemedicine, we encourage an in-person follow-up if your medical concerns do not resolve after a telemedicine visit. *I agree to follow-up for an in-person re-evaluation with a local doctor as neededI have an upcoming appointment with my doctorWhen is your next doctor's appointment? *PreviousNextSupplemental Service Disclosure *We prescribe FDA-approved medications and follow evidence based medical guidelines. In some cases, the initial medication may not completely eradicate your symptoms or cure the infection. In this situation, similar to other clinics and doctor's offices, the patient is responsible to pay for the follow-up visit and repeat treatment.I have been informed that it's my responsibility to handle prescription medication with care and store it in a safe environment. There's an additional fee to reissue lost or misplaced medications.I understand that there is a processing charge of $20 when a request is made for an excuse note or doctor's letterI understand that there's a $50 surcharge when a request for prior authorization or peer to peer review is required by your insurance or payerPreviousNextRefund Policy TermsI am aware that I have a full refund option at any point before ReddyDoc sends my prescription. Our consultation charge is no longer refundable once a medical professional has finished your treatment plan, submitted your prescription to your pharmacy, requested a test, or fulfilled your request.We aim to finish every consultation in under two hours. However, insufficient medical data, technical issues, or a high patient load may cause the turnaround time to be prolonged. Be prompt if you must cancel due to delays. If your request for a refund is made after we have sent your prescription to the pharmacy or finished the treatment plan, the consultation fee is NOT refundable.I am aware that the consultation cost is non-refundable in the event that my body does not respond to therapy or if the prescribed medicine does not entirely cure my disease or eliminate all of my symptoms. You are welcome to submit a second consultation for review.PreviousNextWould you wish to offer a Power of Attorney or an Emergency Contact? Yes, I want to add a power of attorney or an emergency contact.No! Please under no circumstances disclose my medical information to my relatives or friends.PreviousNextEnter the Full Name and Birthdate of the Emergency Contact (IMPORTANT). *PreviousNextDo you want to give the person who handles emergencies access to your medical records? *Yes! I hereby authorize ReddyDoc and its staff to provide my emergency contact with access to my medical records.No! I DO NOT authorize anyone to access my medical record or act on your behalf other than ReddyDoc, its designated agents, and employees.PreviousNextDo you want to pick up your medication at a different pharmacy? *YesNoPreviousNextPharmacy Name *Pharmacy Address *Pharmacy Phone *PreviousNextConsultation FeePrice: $34.99Stripe Credit Card *Submit