RTHM New Patient

1

Did you develop new symptoms during or after COVID-19 infection or COVID-19 vaccination that have lasted more than 4 weeks?* This field is required.

Yes

No

2

Are you age 16 or older?* This field is required.

Yes

No

3

Are you located in California, Oregon, Washington, Florida, or Arizona USA?* This field is required.

Yes

No

4

Do you have active health insurance that covers labs, routine, and emergency care at your location in your state of residence?* This field is required.

Yes

No

5

Do you have a primary care provider who you have seen in the past 6 months?* This field is required.

Yes

No

6

Do you feel comfortable having medical conversations in English without a translator?* This field is required.

Yes

No