Request a virtual consult

With Ricardo L. Rodriguez MD, Baltimore.

*

Please fill out the information below to the best of your ability. All information is confidential.

Patient name
*
*
Patient locality
*
*
*
*
Patient details
*
*
Marital status
Ethnicity
Occupational information
Contact information
Emergency contact information
Women
Check any medical problems that other doctors have diagnosed
Have you ever had a blood transfusion?
Major surgeries/hospitalizations
List your prescribed medications
Allergies: medications, latex, other