Online Consultation – Animisha Dermatology

This platform is designed preferably for review of patients who have already been seen by Doctors in the clinic. New patients can also avail this facility.
It is not an interactive session , the Doctor will review your notes, photograph and get back to you as soon as possible (Usually with in 48 hours) via email/ Phone.
It is designed to help patients who cannot physically attend the clinic.
All the information, details and photograph uploaded are confidential.
If needed the doctor can request you to attend the clinic in person.

Please note that you are choosing to have online consultation out of your own will.
Use this only when you cannot physically attend the clinic.
I hereby give consent to be evaluated by the treating doctor for myself or my relative by online /tele/ digital medium fully understanding the limitations of the technology.
The information given below is true to the best of my knowledge.

Tick to confirm that you have read, understood, accepted the Disclaimer, and ready to fill the details and upload the photos

Full Name

Gender

Male

Female

Age

Phone Number

New customer/ Old customer

New Customer

Old Customer

Animisha Dermatology ID

Last Consultation Date

Review Date(as advised by Doctor)

Please type the reason for seeking the consultation (ex:- Issue with skin, nail or hair)

Please mention all existing medical problems for which you are on medications and any allergies you may have. Eg Diabetes,BP etc