Primary Care Consultation

Please complete Primary Care Consultation Form for review by our US Doctor.
Our team will process it shortly, and will call you to schedule your Telehealth visit!

Note: We provide medical opinions based on online form submissions.

Patient Name: *
Email Address: *
Contact Number: *
Your current Medical concern, including Onset & Duration?
Please indicate any Specific Questions you would like addressed regarding your concern?
Please provide us with a brief Medical/Surgical history.
For USA patients, please include your DOB & pharmacy number.
Please provide us with Any Available Reports

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MyUSADr. services are not intended to address emergency or life-threatening medical conditions.

If this is an emergency, please Call 911 or Seek Local Medical help!