DEMO PREVIEW — This is a working preview of the Evolve Health online questionnaire. It is NOT a real medical intake. Do not enter real health information — nothing you type or upload is sent, saved or stored.
EVOLVE HEALTH
(940) 257-2002
Stop and get urgent care: Call 911 or go to the emergency department now for difficulty breathing, wheezing that does not ease, swelling of the lips, tongue, or throat, trouble swallowing, dizziness or fainting, or widespread hives with any of these — these can signal a severe allergic reaction (anaphylaxis).

Completing this form does not guarantee a prescription. A Texas Clinician reviews every case and decides whether treatment is safe and appropriate.

Step 1 of 12 — Eligibility gates

Are you having any urgent symptom listed above right now? *
I confirm each of the following (all must apply): *

Step 2 of 12 — About you

How may we contact you about this care? *
May we leave a generic voicemail (no medical details)? *

Step 3 of 12 — Identity verification

Before a Clinician can prescribe, we verify identity — this protects you and keeps online care safe. Upload a clear photo of your government-issued ID (driver license, state ID, or passport) and a selfie. The name and date of birth on the ID must match this form. Your ID and selfie are stored only in your secure chart. If your ID cannot be fully verified, any prescription is pickup only. Prescriptions are picked up at your own pharmacy. If your ID cannot be verified, a video visit may be needed first.
Photo of the FRONT of your government ID *
Demo only — files are never uploaded.

Use whichever is easier — Take a photo opens your camera right here, or upload a photo you already have.

Photo of the BACK of your ID — the barcode side *

The barcode on the back must match the front of your ID. This is how we confirm the ID is genuine.

Selfie *

Look at the camera like a passport photo — no sunglasses or hat.

Identity confirmation *

Step 4 of 12 — Your concern and goals

What would you like help with? Check all that apply. *
Note: starting allergy shots (immunotherapy) is in-person only. If that is what you need, the Clinician will route you to an in-person visit at the Denton clinic.
How long have you had these allergy symptoms? *
How much do symptoms affect your sleep, work, or daily life? *

Step 5 of 12 — Symptom pattern and season

North Texas has long, strong pollen seasons. Mountain cedar peaks in winter (about December to February), oak and other tree pollens peak in spring, grasses follow in late spring and summer, and ragweed peaks in fall (about September to November). Telling us when your symptoms flare helps the Clinician match treatment to your season.
Which symptoms do you have? Check all that apply. *
When are your symptoms worst? Check all that apply. *
What triggers your symptoms? Check all that apply. *
Do your symptoms happen mostly indoors, mostly outdoors, or both? *
Do you have fever, colored nasal discharge for more than 10 days, or one-sided facial pain? *
Timing tip: allergy medicines work best when started early. If you know your season, begin treatment 2–4 weeks before your season starts — for example, starting in late fall ahead of cedar season, or in late winter ahead of oak season — and keep taking it daily through the season.

Step 6 of 12 — Asthma and anaphylaxis screen

Allergies and asthma often travel together, and severe allergic reactions need in-person care. Answer honestly — a "yes" helps the Clinician route you to the level of care that keeps you safe.
Check YES for any that apply to you:
In the last 4 weeks, how often have allergy or asthma symptoms woken you at night or limited your activity? *

Step 7 of 12 — Red flags — stop and route

Online allergy care treats everyday seasonal and year-round allergy symptoms. The features below need a different level of care. If any apply, stop here and use the route shown — the care team will help you get to the right place.
Do any of these apply to you right now or in your history? Check all that apply.

Step 8 of 12 — Current allergy treatment and history

Which allergy medicines do you currently use, or have you used before? Check all that apply. *
Have you ever been told you have nasal polyps, chronic sinusitis, or a deviated septum? *
Have you had sinus, nasal, or tonsil/adenoid surgery? *
Any ear pressure, hearing change, or frequent ear infections with your allergies? *

Step 9 of 12 — Health history

Check every condition you have now or have had before: *
Could you be pregnant right now, are you planning a pregnancy, or are you breastfeeding? *

Step 10 of 12 — Medicines and allergies

Have you ever had a bad reaction to an allergy medicine (for example, severe drowsiness, racing heart, or agitation)? *

Step 11 of 12 — How you will receive medication

If the Clinician prescribes, your prescription goes to your own pharmacy for pickup — recommended for a first fill, and the only option if your ID could not be verified. Your insurance can pay for the medication there.
Pharmacy pickup: *

Mail delivery is available for most medications — not all. Some medications need refrigeration or special handling, and some addresses can't be reached by mail. If mail isn't possible for your medication or your address, we'll tell you before you pay, and your prescription will go to your pharmacy for pickup instead — no extra visit charge.

Step 12 of 12 — What happens next + consent

After review, a Clinician may: ask follow-up questions or verify your identity and location; schedule a video or in-person evaluation; request records; recommend allergy testing or an in-person start for allergy shots; or recommend urgent or emergency care if your answers suggest a severe reaction risk. No medicine is promised.

Payment: your card is authorized when you submit and The fee covers your Clinician review and is charged once the review is complete, whether or not treatment is approved. Medication, if prescribed, is separate.
Type your full legal name to confirm each statement: *