High Blood Pressure

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Email *

First Name *

Last Name *

Phone

Date of Birth *

Confirm Date of Birth

Check to confirm date of birth

Gender *

Weight *

Height *

Race

Other Race *

Marital Status

Who is the patient? *

What disease are you suffering from? *

Select Your Location *

Let's match you with an authorized medical professional in your state.

Consent 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 information

Authorization 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.

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.

Do you have a life-threatening symptom or a medical emergency? *

Yes
No life-threatening symptoms

Unfortunately we do NOT treat life-threatening conditions online. Please call 911

Are you focused and alert? *

You must be focused and aware.

Are you allergic to any medications? *

No, there are no medication allergies (NKDA).
Yes

What drugs do you have an allergy to? *

What underlying medical conditions do you have? *

I have no chronic medical or psychiatric issues
Heart disease
Hypertension
Liver disease
Kidney disease
Diabetes
High cholesterol
Thyroid disorder
Psychiatric condition
HIV/AIDS
Other Condition

List any further health issues you may have. *

Type of heart issue *

Coronary Artery Disease (CAD) or heart attack
Heart Valve Disease
Arrhythmias or abnormal heartbeat
Heart Failure or CHF
Congenital Heart Disease
Cardiomyopathy (Heart Muscle Disease)
Pericardial Disease
Other

List other heart conditions that you have *

What's your average blood pressure reading? *

Normal (Less than 140/90)
Elevated (Less than 160/100)
Uncontrolled (Over 160/100)

Type of liver disease

Type of kidney disease *

Kidney stone
Polycystic Kidney Disease
Kidney infection or cyst
Nephritis or nephropathy
Kidney cancer
Elevated creatinine or low GFR
Solitary or Single-functioning Kidney
Other

List other kidney disease *

How 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)

Last thyroid test *

Normal TSH level in the last 12 months
Elevated TSH (or low T4 or T3) level
Low TSH (or low T4 OR T3) level
No thyroid lab test in the last 12 months
I have symptoms of abnormal thyroid disorder

Select applicable psychiatric condition *

Depression
Anxiety
Panic disorder
Bipolar or mood disorder
Schizophrenia or psychosis
PTSD
Eating disorder
OCD
Other

Enter other Psychiatric condition *

Are you currently taking any medication? *

Enter medication name *

Select Applicable Surgical History

No surgical history
Appendectomy
Implanting breasts
C-section
Operations on the gallbladder
Hysterectomy
Hernia surgery
Mastectomy
Surgery on joints
Tonsillectomy
Other surgeries

List any more operations you had in the past.

Select Relevant Social History

Non-smoker
Take many cups of coffee every day.
Smoker nowadays (tobacco, vape, or cigarettes)
Prior smoking or tobacco use
Addiction to prescription drugs
Addiction to alcohol

When was the last time you saw a doctor in person? *

Throughout the previous three (3) months
Between three (3) and six (6) months ago
Recently, between six and twelve months
It was over a year ago.
Never been to a doctor's office in person

How long has your blood pressure been high? *

Less than one week
Beyond a week
Between one and three months ago
It had been almost a year.
My blood pressure is NOT high; it is in the usual range.

Which of these lifestyle choices do you make to regulate your blood pressure? *

Loss of weight
Low-sodium diet
Exercise
Prevent stresses
I do not do anything to manage my high blood pressure.

You must adhere to the following conditions in order to use online hypertension management.

To continue, kindly check all applicable boxes. *

I am aware that I need to have access to a blood pressure monitor.
I commit to visiting a doctor for an in-person checkup at least once or twice a year.
I don't have any significant hypertension symptoms, and I am stable.
I am aware that Reddydoc may ask me to get a lab test if necessary.
I consent to follow up with my doctor if necessary or to seek emergency care right away if my hypertension is not under control.

What is the average measurement of your SYSTOLIC blood pressure (top number)? *

Not more than 120
From 120 to 130
Around 130 to 140
Ranging from 140 to 170
Over 170

Unfortunately we are unable to safely treat you online due to you significantly high blood pressure. Proceed to the ER or Urgent Care immediately

What is the bottom number on your average DIASTOLIC blood pressure reading? *

80 or less
Around 80 to 90
Around 90 to 100
Around 100 to 110
Over 110

Unfortunately we are unable to safely treat you online due to you significantly high blood pressure. Proceed to the ER or Urgent Care immediately

What is the normal heart rate for you? *

60 bpm or less
Approximately 60 to 100 bpm
Always greater than 100 bpm

Unfortunately we are unable to safely treat you online due to your significantly high blood pressure. Proceed to the ER or Urgent Care immediately

Do you currently experience any of these symptoms? *

Respiratory problems, such as shortness of breath,
Chest discomfort
Unsteadiness or hazy eyesight
Palpitations
Slurred speech, weakness, or paralysis
My legs or feet are swollen or edematous.
I do not experience any of these symptoms.

STOP! You're not a candidate for online treatment due to the severity of your symptoms. Please visit a doctor

Have you ever been on a blood pressure medication? *

Yes
I have never taken a blood pressure medicine.

List your blood pressure medications together with their dosages (for instance, 10 mg of lisinopril daily). *

How recently did you last take your blood pressure medication? Pick the closest response. *

Today
Yesterday
This week
Less than a month ago but more than a week ago
Less than three months but more than a month ago
Three months or more

Do you currently take your prescription hypertension medication(s)? *

Yes, as directed, I frequently take my blood pressure medicine.
I don't take my blood pressure medication as often as I should.
My blood pressure medicine ran out.
I've never had a BP medicine administered to me.

Choose your preferred course of treatment (IMPORTANT) *

New hypertension medication to be taken
Please reorder my current blood pressure medication(s)
Stop using your existing BP medication and begin a new one.
Phone Consultation (Only for the Management of Hypertension)

You must submit images of prescription bottles for dose verification in order to refill your BP medication(s). *

I'll post photos of my prescription bottle (recommended)
To confirm, call my pharmacy (doing so could delay your refill).
My blood pressure medicine was previously prescribed by Reddydoc (we'll check).

Pharmacy name

Pharmacy contact number

Upload images of prescription bottle

Click or drag files to this area to upload. You can upload up to 4 files.

How are your blood pressure readings taken? *

With a BP monitor at home
At the pharmacy (Pharmacy)
I lack a device to measure my blood pressure.

To prescribe, we require BP data from 3 different days.

Enter Day ONE BP reading (SBP/DBP). Must be less than 170/110 for approval *

When was the blood pressure reading taken? *

Today
Yesterday
Other

When was this blood pressure reading taken? *

Enter the SBP/DBP reading from Day TWO. For approval, the ratio must be less than 170/110 *

When was the blood pressure reading taken? *

Today
Yesterday
Other

When was this blood pressure reading taken? *

Enter the SBP/DBP reading from Day THREE. For approval, it must be less than 170/110.

When was the blood pressure reading taken? *

Today
Yesterday
2 days ago
Other

When was this blood pressure reading taken? *

Have you undergone a lab test within the last year? *

Yes
I have NOT had blood work in the last one year

Which of the aforementioned blood tests have you examined recently? Multiple options accepted *

Lab tests for the kidneys (include creatine, BUN, potassium, and sodium)
NoTests for the liver, including AST and ALT
Lipid panel (HDL, LDL, TG, and cholesterol)
HbA1c
Blood sugar
Thyroid tests, such as TSH
Not the aforementioned

Choose your preferred treatment strategy. *

($70.00) BASIC: online visit (90 day supply sent to your pharmacy with no refills)
($100.00) ADVANCED: online visit (30 day supply sent to your pharmacy with 5 refills)
($30.00) Monthly subscription with unlimited refills. (You still have to pay for medication at the pharmacy)
($60.00) Quarterly subscription with unlimited refills. (You still have to pay for medication at the pharmacy)

Do you want to order Hba1c, kidney, and other lab tests? *

Yes
No! If labs are needed to prescribe my meds, get in touch with me.

Leave a comment or provide additional medical information (Optional)

How would you like to cover the lab test's cost? *

Self-pay (from own resources)
Using health insurance

Choose the tests you want to add to your cart. *

($35.00) Blood glucose (Diabetes
($40.00) Diabetes (Hba1c
($35.00) CMP (Lab includes kidney, liver, potassium, sodium)
($55.00) Thyroid panel (TSH, T4, T3, TPO)
($40.00) Lipid (Cholesterol) panel
($45.00) PSA (Prostate cancer screening for men only)

Pick your selected tests (The testing facility will submit an insurance claim.) *

CBC (includes platelets, hematocrit, and hemoglobin)
CMP (Lab includes potassium, sodium, liver, kidney)
Diabetes test HbA1c
TSH, T4, T3, and TPO in a thyroid panel
Panel for lipids (cholesterol)
PSA (for men only; a test for prostate cancer)

Leave a comment or feedback (Optional)

Weight Reduction & Safety Disclosure *

I am aware that using a weight-loss drug may not always lead to weight loss, especially if I don't also follow a healthy diet and exercise routine. I thus consent not to hold reddydoc accountable for my inability to lose weight on this medication.
I am aware that Plenity® therapy is used as a supplement to calorie restriction and increased physical activity for long-term weight management.
I know that among Plenity®'s potential adverse effects include flatulence, frequent bowel movements, diarrhea, and an enlarged belly.
I've been told that Plenity should not be used by pregnant or nursing women.

Important Information: The cost of drugs is not covered by the consultation fee. *

I am aware that even if my insurance does not cover a particular prescription, I will still need to pay for it at my local pharmacy.

Agreement for follow-up *

I recognize this and consent to taking the patient to the emergency room right away if their symptoms worsen or continue.

Given 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 needed
I have an upcoming appointment with my doctor

When is your next doctor's appointment? *

Supplemental 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 letter
I understand that there's a $50 surcharge when a request for prior authorization or peer to peer review is required by your insurance or payer

Refund Policy Terms *

I 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.

Would 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.

Enter the Full Name and Birthdate of the Emergency Contact (IMPORTANT). *

Do 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.

Enter the Full Name and Birthdate of the Emergency Contact (IMPORTANT). *

Pharmacy Name *

Pharmacy Address *

Pharmacy Phone *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Consultation fee

Price: $34.99

Stripe Credit Card *