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Plan a

Includes:

  • Review of 1 diagnosis (this may be substituted for a"chief complaint" in a case where diagnosis is not clearly established)

  • Your specific concern related to the diagnosis

  • Review of your medical notes from your physician

  • Brief review of medications, labs, etc if related to the chief complaints

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All the information we need is in the form below.

If we need any additional information, we will contact you.

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If you have any other questions, please visit our FAQs page.

**Our report is only as good as the information provided. Please be sure to provide legible documents/medical notes from your primary care physician or through your online health portal. Under the CARES Act, every patient has the right to all of their medical notes/records instantly through an  online portal. You may request this from your physician's office or hospital.**

Medical specialties we currently do not review: pediatrics, oncology, oculoplastics, and few other rare sub-specialties.

If the form below does not open in your browser, try a different browser. If you still have technical issues, email us at support@counselmd.com, and we will send you a link to the form.

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