modesto – Modern Urgent care App

Do you have an appointment already?

yes

no

You are already at the beginning.

You must select an option.

What is bringing you in?

Let us know why you are seeking care.

You are already at the beginning.

You must select an option.

What is the Ear Infection location?

Right

Left

Both

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You must select an option.

What is the Rash location?

You are already at the beginning.

You must select an option.

Did you receive the measles vaccination?

Yes

No

You are already at the beginning.

You must select an option.

Do you want a Skin Test?

Yes

No

You are already at the beginning.

You must select an option.

Do you want a Skin Test Reading?

Yes

No

You are already at the beginning.

You must select an option.

Do you want a Blood Work Request?

Yes

No

You are already at the beginning.

You must select an option.

Do you have any covid or flu symptoms?

Yes

No

You are already at the beginning.

You must select an option.

Do you have any recent positive exposure to covid or flu?

Yes

No

You are already at the beginning.

You must select an option.

Do you have any recent positive exposure to covid or flu?

Yes

No

You are already at the beginning.

You must select an option.

What is the injury location?

You are already at the beginning.

You must select an option.

Were you injured at your workplace?

Yes

No

You are already at the beginning.

You must select an option.

Have you experienced loss of consciousness, nausea, vomiting, or change in behavior?

Yes

No

You are already at the beginning.

You must select an option.

Medication name, dosage, frequency?

You are already at the beginning.

You must select an option.

When was your last refill?

You are already at the beginning.

You must select an option.

Do you have an upcoming appt with PCP or specialist?

Yes

No

You are already at the beginning.

You must select an option.

Any chance of pregnancy?

Yes

No

You are already at the beginning.

You must select an option.

What is the pain location?

You are already at the beginning.

You must select an option.

Are you also experiencing cough or congestion?

Yes

No

You are already at the beginning.

You must select an option.

Are you experiencing chest pain?

Yes

No

You are already at the beginning.

You must select an option.

Do you have a history of Asthma, COPD, or anxiety?

Yes

No

You are already at the beginning.

You must select an option.

Are you also experiencing cough or congestion?

Yes

No

You are already at the beginning.

You must select an option.

Are you also experiencing shortness of breath or numbness?

Yes

No

You are already at the beginning.

You must select an option.

Do you have a history of anxiety, hypertension, or diabetes?

Yes

No

You are already at the beginning.

You must select an option.

What is patients full name?

As it appears on your government card.

You are already at the beginning.

You must provide a valid name.

What is patients gender?

male

female

other

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You must select an option.

What is patients phone number?

This number will be used to contact you for alerts and if any questions or conflicts arise.

Use the phone number you have with us before. Otherwise you can put your new number in.

You are already at the beginning.

You must provide a valid phone.

What is patients email?

This email will be used to contact you for alerts and if any questions or conflicts arise.

Use the email you have with us before. Otherwise you can put your new email in.

You are already at the beginning.

You must provide a valid email

Which month were you born in?

You are already at the beginning.

You must select an option.

Which day were you born in?

You are already at the beginning.

You must select an option.

Which year were you born in?

You are already at the beginning.

You must select an option.

Have insurance?

yes

no

You are already at the beginning.

You must select an option.

Who is your insurance provider?

You are already at the beginning.

You must select an option.

What is your insurance id number?

Primary Insurance Id Number

You are already at the beginning.

You must provide a valid insurance id number

Do you have an appointment already?

What is bringing you in?

What is the Ear Infection location?

What is the Rash location?

Did you receive the measles vaccination?

Do you want a Skin Test?

Do you want a Skin Test Reading?

Do you want a Blood Work Request?

Do you have any covid or flu symptoms?

Do you have any recent positive exposure to covid or flu?

Do you have any recent positive exposure to covid or flu?

What is the injury location?

Were you injured at your workplace?

Have you experienced loss of consciousness, nausea, vomiting, or change in behavior?

Medication name, dosage, frequency?

When was your last refill?

Do you have an upcoming appt with PCP or specialist?

Any chance of pregnancy?

What is the pain location?

Are you also experiencing cough or congestion?

Are you experiencing chest pain?

Do you have a history of Asthma, COPD, or anxiety?

Are you also experiencing cough or congestion?

Are you also experiencing shortness of breath or numbness?

Do you have a history of anxiety, hypertension, or diabetes?

What is patients full name?

What is patients gender?

What is patients phone number?

What is patients email?

Which month were you born in?

Which day were you born in?

Which year were you born in?

Have insurance?

Who is your insurance provider?

What is your insurance id number?

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