We are looking for:

1. A basic summary of the case

2. Pertinent lab results

3. What meds have been tried and with what success

4. Generally what you/client are looking to gain from this consult

5. Please refrain from entering "see records". A brief summary for each section is requested

6. Please attach and send the records with this form. You can alternatively email the records to contact@vogelvetderm.com, or fax to 603-379-8643