Address: 915 Middle River Dr #213, Fort Lauderdale, FL 33304

Virtual Consultation Form

Virtual Consultation

  • Personal Profile

    This form is for Out of Town Patients only. We respond Monday through Friday after 24 hours. Please check your spam or junk email for our reply. Fields marked with * are required.
  • Please enter a number from 1 to 99.
  • Please enter a number from 1 to 600.
  • Contact Method

  • Date Format: MM slash DD slash YYYY
  • Please enter a number less than or equal to 99.
  • Upload Picture

    ​Please use the upload button below to upload photos to send to us: To make the most out of your virtual consultation, do your best to submit your photographs in the following format. This will allow our doctors to make the most comprehensive assessment.
    1.Use a solid background.
    2.Take one frontal photo with the face or body-centered and looking straight.
    3.Take at least one, preferably two profile photos.

  • Communications through our website or via email encrypted.