Providing us with an accurate, up-to-date medical history will allow our physicians to tailor your course of treatment. All you have to do it click on the link below, print the form, fill it out and bring it with you to your appointment OR edit the form and email to firstname.lastname@example.org.
Essential Telemedicine Services
- Athlete’s Foot
- Cold Sores
- Poison Ivy
- Skin Infection
- New Painful or Spreading Rashes
- New Blisters
- New Onset of Severe Skin Pain
- Concern of Melanoma Skin Cancer
- Post Skin Cancer Surgery Complication
- Post Cosmetic Procedure Complication
Complete the Telemedicine Forms
Click on the buttons to download & print the PDF forms.
Cosmetic Department Virtual Consultations
Cosmetic Department Virtual Consultations may be scheduled for $75, which will be applied toward product or service.