Tele Dermatology

Online Consultation - Skin related problems

Please fill the below form, provide detailed information on existing medical condition, past medical history, current/past medications and attach available scan reports and pictures preferably high quality images as it would help our physicians to examine your ailment(s) with more clarity.

(Step 1 of 4) Basic Information


New / Old Patient

(Step 2 of 4) Let us know about your problems and duration of the condition


Itching
Pain

(Step 3 of 4) Tell us know more about your general health and wellness


Co Existing Medical / Surgical Conditions

Current medications / Previous treatment details

(Step 4 of 4) Send your images and relevant documents

Please provide high quality pictures as it would help our physicians to examine your ailment(s) with more clarity.
(Please upload maximum of 1MB files only, all inclusive.)
Add More
(Please upload maximum of 1MB files only, all inclusive.)
Add More
(Please upload maximum of 1MB files only, all inclusive.)
Add More
(Please upload maximum of 1MB files only, all inclusive.)