Explain your symptoms or tell us how we can help today.*

Do you have allergies to any medications?*

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If yes, please list any medications you have allergies to:

Are you pregnant or breastfeeding?*

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Unfortunately we cannot proceed with your request based on the information you have provided.

Have you ever been diagnosed with hypertension?*

Yes
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What medications were you treated with?*

Why did you stop treatment?*

Provide your blood pressure reading on 3 separate days (You can go to your nearest pharmacy or Walmart to have your blood pressure taken for free)-Please note we will be unable to provide you treatment without these blood pressure reading results.*

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Smoker?*

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Never

Alcohol use?*

Any medical family history?*

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Do you have any medical conditions?*

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Please explain your medical conditions:*

Have you ever had any surgeries or recent hospitalizations?*

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Please explain your surgeries or recent hospitalizations:*

Do you currently take any medications, herbals, or supplements?*

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Please list any medications, herbals, or supplements:*

Upload 3 sets of blood pressure readings*

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Please upload clinically relevant images, video, labs, pathology reports and other medical records.

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