Please upload your patient photos using this form

In addition to uploading patient photos please fax a referral form to the office and indicate photos have been sent

  • Drop files here or
    Max. file size: 16 MB, Max. files: 2.
      Accepted file types: jpg, jpeg, png, gif. Click submit once all images have finished uploading.
      Please ensure a completed patient referral is also sent to our office by fax to accompany any uploaded photos. Referrals will only be processed once accompanying referral is received by fax.
    • This field is for validation purposes and should be left unchanged.
    Accepted file types: jpg, jpeg, png, gif. Click submit once all images have finished uploading.

    Please ensure a completed patient referral is also sent to our office by fax to accompany any uploaded photos. Referrals will only be processed once accompanying referral is received by fax.