Please note: If you are having a medical emergency please call 911 or go to your nearest emergency room

This form is for existing patients who are looking to conduct a virtual follow-up appointment following a procedure or treatment.

Required fields are marked with an asterisk *.
Your personal information will not be shared with, or sold to, anyone outside of our organization for any reason.

Telemedicine Consent Form**

**Please make sure you have filled out the telemedicine consent form

Online Follow Up

  • Date Format: MM slash DD slash YYYY
  • 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.
    4. Please include closeup photo/photos of your recent incision(s)
    Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

    By checking this box you hereby agree to hold Dr. Jonathan Hall and affiliates harmless from any hacking or any other unauthorized use of your personal information by outside parties.