COPD MIF – GoodpillRx

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Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Home
Shop
For Providers
About us
Contact us

Generic selectors

Exact matches only

Exact matches only

Search in title

Search in title

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Post Type Selectors

product

product

post

post

page

page

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product_variation

Filter by Categories

Uncategorized

Uncategorized

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

COPD MIF

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

What is your date of birth?*

MM slash DD slash YYYY

What is your height?*

What is your weight?*

What is your gender?*

Male

Female

Are you currently breastfeeding, currently pregnant, or may become pregnant in the near future?*

Yes

No

Not sure

Please list all medications prescribed to you even if you don't take them every day. Include vitamins, and dietary supplements. Enter medicines including name, dose, frequency, and reason for taking.*

Please list your allergies, including any allergies to medications.*

Have you been diagnosed with COPD?*

Yes

No

Are you currently having a COPD exacerbation?*

Yes

No

Do you have any of the following risk factors?*

Occupational dusts, vapors, fumes, gases and other chemicals

Tobacco smoke

Smoke from home cooking and heating fuels

Low birthweight

Recreational drug use in the last year

Childhood respiratory infections

None

Does anyone in your household smoke cigarettes?*

Yes

No

Which of the following triggers apply to you?

Environmental allergies

Exercise

Weather changes

Respiratory illnesses (i.e. common cold, COVID-19, sinus infections, etc)

Cigarette smoking

In the past 4 weeks, have you experienced any of the following?

Shortness of breath, chest heaviness, air hunger, gasping

Chronic cough

Wheezing

Chest tightness

Fatigue

Sputum production

In the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (not including pre-exertional use)?*

3 or more times per day

1-2 times per day

1 time per week or less

Not at all

Which classification most likely apply to you?

You have no symptoms. You might experience some shortness of breath when walking fast or climbing a slight hill.

You have to stop every few minutes to catch your breath when walking on ground level.

You are too short of breath to leave the house. You might get breathless when dressing/undressing.

You have lung/heart failure making it hard to catch your breath when resting.

How many COPD exacerbations have you had within the past year?*

1 or less

2 or more

Do you have any of the following medical problems?*

High blood pressure

History of ketoacidosis

Low potassium levels

Overactive thyroid gland (hyperthyroidism)

Heart disease or irregular heartbeat

Seizures

Liver disease

Kidney disease

Glaucoma

Bladder obstruction (i.e. BPH)

Asthma

None

Are you currently taking potassium supplements?*

Yes

No

Please select which of these substance you currently use.*

Alcohol

Amphetamines

Barbiturates/Owners

Caffeine

Cocaine

Crack cocaine

Hallucinogens (e.g. LSD)

Inhalants (e.g. glue, gas)

Marijuana

Nicotine/cigarettes

PCP

Others

None

please specify.*

How much do you smoke? How long have you been smoking?*

How much alcohol do you drink?*

2-5 drinks daily

1 drink daily

A few drinks per week

A few drinks per month

Occasionally

Almost never

Never

What asthma medications are you currently prescribed? Please include the dose and frequency of use.*

Which medications do you currently need refills for?

Are you currently on any oxygen therapy?*

Yes

No

Are you taking any beta blockers (i.e. atenolol, carvedilol, labetalol, etc.)?*

Yes

No

have you noticed an increase in your COPD symptoms while taking this medication?*

Yes

No

Have you had the following vaccinations?*

Influenza (winter of 2021-2022)

Pneumococcal (PPSV23) for < 65 year olds

Pneumococcal (PCV13) for 65+ year olds

dTaP/dTPa

COVID-19

Shingles (herpes zoster)

Provide a recent heart rate and blood pressure measurement. This can be from a recent appointment (within the past 6 months) or you can have these measured for free at most local pharmacies such as CVS or Walgreens.

Finally, is there anything else we should know?*

Yes

No

Please briefly explain.*

GoodpillRx is dedicated to helping our patients have access to quality, affordable medications, delivered straight to their door.

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