Ear Infection

Explain your symptoms or tell us how we can help today.*

Do you have allergies to any medications?*

Yes
No

If yes, please list any medications you have allergies to:

Are you pregnant or breastfeeding?*

Yes
No

Unfortunately we cannot proceed with your request based on the information you have provided.

Have you recently been swimming?*

Yes
No

Do you suspect water got inside your ear canal during routine bathing or showering?*

Yes
No

Any history of ear surgery?*

Yes
No

Did you have tubes placed in ears?*

Yes
No

Which ear is affected?*

Right
Left
Both

What symptoms have you been experiencing recently?*

Unfortunately we cannot proceed with your request based on the information you have provided.

Describe your ear pain:*

Sharp
Dull
Throbbing
Stabbing

Describe your fever or chills:*

Feeling warm no measured temperature
Measured temperature of 100.8 degrees (fahrenheit) or higher
Severe uncontrollable chills (teeth chattering)

Unfortunately we cannot proceed with your request based on the information you have provided.

If you've listed "other", please explain your symptoms:*

How long have you been having these symptoms?*

Started today
1-3 days
4-7 days
Over 1 week

Have you ever been diagnosed with an ear infection?*

Yes
No

What medications were you treated with?*

Antibiotics
Anti-inflammatory drugs
Benzocaine (anesthetic)
Steroids

Did treatment work?*

Yes
No

Smoker?*

Yes
No
Never

Alcohol use?*

Any medical family history?*

Yes
No

Please explain your medical family history:*

Do you have any medical conditions?*

Yes
No

Please explain your medical conditions:*

Have you ever had any surgeries or recent hospitalizations?*

Yes
No

Please explain your surgeries or recent hospitalizations:*

Do you currently take any medications, herbals, or supplements?*

Yes
No

Please list any medications, herbals, or supplements:*

Scan/Upload any Relevant Medical Images:

Max. file size: 32 MB.

Email

This field is for validation purposes and should be left unchanged.

Ear Infection

Ear Infection

Step 1 of 2

Before You Continue - Please Review Our Informed Consent Agreement