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Cold/Cough Symptoms Intake
Symptoms for Cold/Cough patients at KnowNOW Health
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Email
*
Your email
Name
Your answer
Have you had difficulty breathing?
Yes
No
Clear selection
Have you had a fever?
Yes
No
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If you've had a fever, how high, and when was your last fever?
Your answer
Is your cough productive or dry?
Productive
Dry
No cough
Clear selection
Do you have any other symptoms? (check all that apply)
Headache
Congestion
Sore throat
Ear pain
Nausea
Vomiting
Diarrhea
Body aches
Do you have a normal appetite?
Yes
No
Clear selection
Do you have any problems urinating?
Yes
No
Clear selection
Do you have any other pain or symptoms we should know about?
Your answer
List any medication allergies:
Your answer
List any medications you are currently taking:
Your answer
Virtual visit preference
Voice call
Video call
No preference
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Send me a copy of my responses.
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