Early Outpatient Treatment of COVID-19

Early Outpatient Treatment of COVID-19, Patient Information and History Form. Please Complete The Fields As Indicated (Required fields indicated by “*”, Then Complete SUBMITSUBMIT

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Your sex
Have you completed the initial two-shot COVID-19 vaccination series?
Are you having any of the following?
If you are having any of the above symptoms, for how many days have you been having them?

Your height ( in feet and inches)(for example, 5 feet, 6 inches)

Do you have any of these chronic conditions?
Check if you are allergic to any of these:
If you have had a COVID-19 test, what was the result?
Are you a member of either of these COVID high risk groups?
Requests for medications for the early outpatient treatment of COVID-19 submittedby 12 noon (Pacific Time) will be answered by 5 pm of that day if possible, thosesubmitted after 12 noon (Pacific Time) will be answered by noon of the next day, ifpossible. If you do not see a response, check your spam folder. We prioritize from theoldest to the youngest and by high to low risk racial groups. Do you wish to havemedications for early outpatient treatment of COVID-19?
The chain pharmacies are refusing to fill ivermectin prescriptions. The followingpharmacies have such prescriptions. Select one or make your own suggestion if youknow they take such prescriptions:
TeleHealth & Follow-Up Authorization: I give permission to this office to treat me by means of telehealth services pursuant to Governor Newsom's Order of April 3, 2020,to communicate with me through the email address provided above, and to contact me by email not more than once per week for a short follow-up inquiry on myprevention and/or treatment program only, no marketing emails.

Required HIPPA Privacy Practices Notice: View our privacy practices here

HIPPA Notice Provided?
Required Medical Board of California Notice To Consumers: Richard B. Fox, M.D.,J.D., CA Medical License #G67169 provides this NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322, www.mbc.ca.gov. Click "yes" to acknowledge receipt of this legally required notice.
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The charge for this service is $100, payable by Zelle (Zelle details here) to phone number 408-402-2452. We will send you your evaluation and recommended treatment before payment but payment must be received before your prescriptions can be sent to your pharmacy.