Symptom Checker

Help patients describe symptoms before consulting a provider

6 fieldsconversationalHas conditional logicHealthcare

Fields included

Full name*

Short text

Which symptoms are you experiencing?*

Multi-select

How severe are your symptoms?*

Dropdown

When did the symptoms start?*

Date

Are you currently taking any medication for these symptoms?*

Yes/No

↳shows “Which medications are you taking?” if equals“true”

Which medications are you taking?

Short text

Help patients describe symptoms before consulting a provider

Full name*

Type here...

Which symptoms are you experiencing?*

Select multiple...

How severe are your symptoms?*

Select...

When did the symptoms start?*

MM/DD/YYYY

Are you currently taking any medication for these symptoms?*

Yes

Which medications are you taking?

Type here...

Submit

Collect essential patient information before their first visit

Let patients request appointments online at their convenience

Allow patients to request prescription refills online