Health History Form

Covid-19 prevention and out-patient treatment.

Let’s Get Started

Thank you for contacting us. We will be happy to help you with a prescription for ivermectin and other medications as needed for prevention or treatment of COVID-19. Below is our New Patient Form. Simply type in your answers and email it back to us. If you have other family members and friends who need the form, just forward this email to them.

After we receive your email, we will contact you. We make our best effort to get back to patients the same day to arrange a consultation with Dr. Ashley Magee, NMD, for any prescriptions that are necessary.

The initial consultation fee for this service is $145. We do not accept insurance. We accept PayPal, debit, and credit cards.

If you have any questions, do not hesitate to contact us via this email address, [email protected]. We are here for you. If perchance we drop the ball – some days we are inundated – please pick up the ball and toss it back. We are all on the same team.

Name

Phone

Date of birth

Age

Gender

Height

Weight (lbs)

Email Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Current or Past Occupation

Are you looking for preventative treatment?Please type Yes or No

Are you concerned that you have been exposed in the last 2 weeks?Please type Yes or No

What symptoms do you have that you think may be due to COVID?Please describe your current situation with this health challenge. When did this start? Then what happened? Include any relevant dates.

Are you looking for answers to post-COVID long hauler issues?Please type Yes or No

Have you been vaccinated against COVID-19? What product was given to you and on what date?Please type Yes or No

Are you looking for preventative treatment?Please type Yes or No

Do you have a history of asthma or other lung condition?Please type Yes or No

Other medical conditions/concerns. This includes all medical conditions for which you are taking medications.

Medications and Supplements: List all prescribed and over-the-counter. Also any anti-coagulant/blood thinner medication?

Allergies (to medications, mold/dust/pollen, animals, food, chemicals, etc.)

Pharmacy

Ivermectin has become challenging to obtain from corner pharmacies due to recent shortages and other reasons. But the good news is, we have found a number of independent pharmacies that have no problem getting it, no problem filling it, charge a fraction of the price of your local pharmacy (even compared to the GoodRx price), and answer the phone. You can pick up your prescription, or it can be delivered or shipped to you. During your appointment, we will discuss which pharmacy to use.
Other medications are not as challenging to obtain from local pharmacies so give us the phone number for your local Fry’s, Safeway, Albertsons, Bashas, etc. We have found that the pharmacies associated with grocery stores have the better prices and could save you as much as $75, depending on the medications prescribed. When you go to the pharmacy to pick up your prescriptions, be sure to use the GoodRx coupon you can find on your computer at www.GoodRx.com – or you can pull up the coupon on your smart phone to show the pharmacist. It can decrease the price on some medications by up to 95%.

Feel Free to Ask us Any Questions!

Dr. Linda Wright, Owner/Director

(602) 565-9273

Health History Form

Let’s Get Started

Pharmacy

Feel Free to Ask us Any Questions!

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