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Virtual Consultation – Skin Assessment

1 Contact Information

2 Detailed Information

3 Upload Photos

First Name*
Last Name*
Gender*
Age*
City, State, Country
Phone*
Email*
Reason for your Consultation (List All)*
Medical history information the doctor should be aware of?

Photos of the areas you are wishing to improve are required before recommendations can be made. Scroll down to see photo instructions below.

We respect your privacy. Your images, by law, will be kept on a highly secure server. However, if you’re a bit wary of sending pictures, please call to speak with one of our Nurses or Aesthetic Consultants (not a salesperson). We’re sure you will feel more comfortable after a brief conversation.
Max of 6MB per image. 4 images max. JPG, JPEG, GIF, or PNG.
Drop files here or
Accepted file types: jpg, gif, png, jpeg.
Who referred you to us or how did you hear about us?
Please tell us any other relevant information that will help our team to develop the best treatment plan for you.
Photo Instructions
1. Please take photos in front of a plain background. For example, use a plain-colored wall or plain-colored sheet (white is preferable).
2. Photos should be taken from a relaxed natural position with lots of lighting.
3. Keep the camera angle straight forward. Do not angle down or up as this will also create an unnatural view and create shadows that may obscure the view.
4. A total of 2 images are needed: 1 at a natural distance and 1 close-up.
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* DISCLAIMER: Individual results vary. Patient testimonials, images or videos do not constitute a promise or representation of any particular outcome or experience. Each patient’s experience, recovery and results will be unique depending on their skin, age, health and other individual factors. Best results may be promoted with a proper diet and regular exercise. Users should review the "terms of use" before using the Web site. This web site is for information only. Do not use the information herein to diagnose or treat your cosmetic surgery or medical problems. You should contact your physician with all medical questions and concerns before using this website. Proudly serving the tri-state area for over 30 years, including New York cities such as Warwick & Middletown, New Jersey cities such as Sparta & Lake Hopatcong, and Pennsylvania cities such as Scranton & Wilkes-Barre © by Pocono Medical Care, Inc. and Richard E. Buckley, MD. All rights reserved.
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Virtual Consultation – Skin Assessment

MilfordMD Cometic Dermatology Surgery & Laser Center