LETTER OF RECOVERY FROM COVID-19 FOR TRAVEL

Telemedicine request for letter of recovery from COVID-19 for domestic and/or international travel.

Please note: We ask that you double-check the spelling of your name and that your birth date is correct. All documentation must match your travel documents.

Address

Country

State/Province

By selecting yes and submitting this form, you acknowledge that you have been recently diagnosed and tested positive for the COVID-19 virus.

Yes

By submitting this form you are acknowledging that:

Check all that apply:

You were recently diagnosed within 90 Days
At least 5 days have passed since symptom onset and test results
At least 24 hours have passed since the resolution of your fever without the use of fever-reducing medications
Other symptoms have improved

Are you completely symptom free now?

Yes
No

I acknowledge I am paying for a teleconsult with the physician which does not guarantee I will receive a covid letter of recovery unless clinical criteria are met. The outcome will be based solely on the physician's medical discretion and the fee is non-refundable.

Upload your positive COVID-19 test results here:

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How did you hear about us?

Please choose one:

Google
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Drive-by
Referral

To release your information, please e-sign below

Billing Address

* Country

* State/Province

Sub Total

$125.00

TOTAL

$125.00

Payment Method

Credit Card - Square

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Thank you for contacting us!

Covid-19 Telemedicine/Letter of Recovery Hours:

Hello, we've received your Covid-19/Letter of Recovery intake Form. Our Feel Ideal 360 Team member will respond to you by the end of the business day. Calls will be made until 11 pm central time to accommodate for high volume.

Dr. Straface will call you at her next available opportunity, so please be sure your phone settings for unknown/spam blockers are turned off.

Online Covid-19 SATURDAY/SUNDAY INTAKES WILL BE RETURNED. Our offices are closed on weekends. However, All Covid-19 Intake forms received Saturday and Sunday will be returned therefore please do not call our office.

Regarding your Upcoming – Letter of Recovery Telemedicine Call

We appreciate your patience during this busy time. Please note, calling our office may only further delay the process given the extraordinary number of calls are receiving. Please email us should you need additional assistance.

A

Dr. Straface and the

Feel Ideal 360 team

View Submission