HOW TO SCHEDULE YOUR VIRTUAL CONSULTATION

Registration Form(s)

HIPAA ACKNOWLEDGEMENT

  1. Fill out the request form.
  2. We’ll contact you to talk about your consultation.
  3. Be prepared to send us pictures for your consultation, OR download the MyTouchMD App from our website, and place the photos directly into this secure portal.

Request Form: Please enable JavaScript in your browser to complete this form.

MyTouchMD for Android

MyTouchMD for Apple

REQUEST FORM

  • Optional File Upload

  • HIPAA ACKNOWLEDGEMENT

    Please be aware that this is a secure email network under HIPAA guidelines. Do not submit any personal or private information unless you are authorized and have voluntarily consented to do so. We are not liable for any HIPAA violations. Understand that if you email us, you are agreeing to the use of this secure method and understand that all replies will be sent by standard (unsecured) email, which you are hereby authorizing. By checking this box you hereby agree to hold Cosmetic Plastic Surgery of Maryland, including its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.
  • User Consent