Virtual Pre-Consultation

If you would like to have your eye issues go through a preliminary evaluation for some peace of mind, or to consider a cosmetic treatment, we would be happy to do a virtual, preliminary evaluation of your case at no charge. Any advice given is for guidance purposes only, and does not not constitute a doctor-patient relationship.

A formal consultation in-person with Dr. Prasad, or a one-on-one Skype consultation can be arranged here (we need a Contact Us page for eyelifts).

Fill out your information below and submit your images to start your free Virtual Pre-Consulation:


Contact Information

How to contact you: (* Indicates required field)

*First Name:
*Last Name:
*Phone Number:
*Email Address:
Street Address:
City:
*State / Province:
ZIP / Postal Code :
*Country:

Preferred Contact Method:

  Phone     Email



Best Time to be Contacted: 

Best Day to Be Contacted: 

What eye issue(s) do you want treated?

Puffy eye bagsHollowness in lower eyelids/ tear troughsDiscoloration in lower eyes/ dark circlesUnder eye wrinklesHooded upper eyelidsDrooping upper eyelid(s)Ptosis correctionGrowth/nodule/lesion in eye areaThyroid eye disease/Graves’ diseaseScleral showOther (please indicate)

Repair of previous eyelid surgery (please specify original surgery)

Message/Comments:

Photo submission:

Photos provide a clearer explanation of your eye area issues, but do not take the place of a physical examination/ formal consultation.

Front view


Side view


Submissions for a video answer

Would you like to be part of a featured video where Dr. Prasad gives an analysis of your eye issues? These videos are publicly viewable, but only areas specific areas of your face are visible to protect your privacy.

Yes, I will allow images to be used in a publicly viewable videoNo, I will not allow my images to be viewed publicly, and would like a confidential preliminary evaluation

While every effort is made to keep your information confidential, the internet and email communication are inherently subject to breaches of privacy. Our privacy statement is viewable before your details listed here are submitted

Review and Submit

x

Disclaimer and Privacy Statement


Your submitted information and images, as well as all subsequent correspondence do not constitute a doctor-patient relationship. Virtual consultation is meant for preliminary evaluation, inquiry, and appointment scheduling only. Virtual consultation is not a substitute for an in-person, in-office physical examination by the doctor(s) or any medical personnel. A formal consultation can be scheduled after the submission of your information, by contact through phone, or through correspondence. A formal consultation only takes place only within our offices with a physical exam by the doctor(s), or through a one-on-one video consultation through Skype.


Your information and submitted photos will be used for your personal medical file only, and will not be used or sold for any promotional purposes, including our own websites, videos, or any third party. Given that the internet and email have potential security issues, we are not liable for any breach that gives an unauthorized party access to your information and images.


Prospective patients must disclose any medical information from previous consultations or diagnoses from other physicians. Any withheld information on current or past medical conditions that may affect our prescribed treatments and procedures frees Prasad Cosmetic Surgery from any liability.


Should you choose to become a Prasad Cosmetic Surgery patient, the treatment does not claim to universally benefit all patients, and treatment results will vary among individual patients. No guarantees of effectiveness are claimed or promised by Prasad Cosmetic Surgery.