Virtual 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. Any advice given is for guidance purposes only, and does not not constitute a doctor-patient relationship.


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 bags Hollowness in lower eyelids/ tear troughs Discoloration in lower eyes/ dark circles Under eye wrinkles Hooded upper eyelids Drooping upper eyelid(s) Ptosis correction Growth/nodule/lesion in eye area Thyroid eye disease/Graves’ disease Scleral show Other (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 video No, 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.