Phone: (815) 284-8000
Patient Name -- (required)
Name (if different than patient name, i.e. parent or guardian)
Pharmacy Fax #
Select your Telemedicine Kit
COVID-19FluStrepUTIAnemiaBirth ControlErectile Dysfunction
Symptoms Patient is Experiencing
COVID-19/Coronavirus symptomsSore throatFlu-like symptomsFatigueDiscomfort when urinatingErectile Dysfunction symptomsOther/none of the above
I certify that I have read and accept the terms of Physician 360's Informed Consent.
300 State Street, Unit 92202
Southlake, TX 76092
© 2021 Physician 360 Inc.
How to Diagnose Strep
Rapid COVID Test
Strep VS COVID