What symptoms prompt you to seek medical help?
Fever Cough Pain Fatigue Others
What type of healthcare provider do you prefer to see initially?
General Practitioner Specialist Nurse Practitioner Physician Assistant No preference
How important is the proximity of healthcare facilities to you?
Very important Moderately important Not very important Not important at all Prefer remote consultations
What communication method do you prefer for medical updates?
Phone calls Emails Text messages Patient portal Video calls
All set, how can we reach you?
Name
Email
Phone
(Details here)
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