Photo Re-verification Survey

1

* This field is required.Patient ID

2

We're sorry! This survey has been updated, and you'll need a new link. Please reach out to support@torchrx.com.

3

Please take a selfie/photo of yourself, and upload it here.* This field is required.Make sure we can see your face and upper body clearly: remove hats, glasses, and the photo should not have any other people in it.

4

Final step, take a photo of your government-issued ID.* This field is required.Make sure full name and DOB are clearly visible, all edges are showing, and the ID is a valid driver's license or passport.