Ventus General Health MIF – GoodpillRx

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

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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

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

Search in content

Search in content

Search in excerpt

Post Type Selectors

product

product

post

post

page

page

product variation

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

Ventus General Health MIF

Name(Required)

First Last

Email(Required)

Phone(Required)

Date Of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Address(Required)

Street Address City State ZIP Code

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 allergies to medications.

What is your height?

What is your weight?

Do you currently suffer from any of the following? (Select all that apply)

High blood pressure

Agina

Palpatations

Murmurs

Clots

Asthma

Emphysema

Bronchitis

Pacemaker

Defibrillator

Have you been diagnosed with diabetes?

Yes

No

what type of medicine are you using?

Insulin

Pills

When was your last foot exam?

When was your last eye exam?

Have you ever had a stroke?

Yes

No

what was the date?

Have you ever been diagnosed with cancer?

Yes

No

what type of treatment did you receive?

Chemotherapy

Radiation

Surgery

Other

other

what type of cancer were you diagnosed with?

Have you ever been hospitalized?

Yes

No

what was the date of the hospitalization? What was it for?

Have you ever had any surgeries?

Yes

No

Please list all surgeries including those related to dentistry.

Please list all of the medical conditions you are currently diagnosed with that were not already addressed.

Have any family been diagnosed with cancer?

Yes

No

please list all cancers present in your family and how that person is related to you.

Please list any genetic diseases you are aware of in your family.

Do you exercise regulary?

Yes

No

How often per week do you exercise?

Do you smoke cigarrettes or use tobacco products?

Yes

No

How much do you smoke per day?

How long have you been using tobacco products?

Do you drink alcohol?

Yes

No

How often do you drink alcohol?

1-2 drinks per day

3-4 days per week

1-2 per month

A few times per year

Frequency

Do you use any recreational drugs?

Yes

No

Please all drugs you use recreationally?

Are you sexually active?

Yes

No

Do you have only one partner or multiple?

One partner

Multiple

What is your current relationship status?

Single

Dating

Married

Do you practice safe sex?

Yes

No

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

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