• Let's get started!

    Step 1 of 6
  • Referrer
  • Current Date*
     - -

  • WE'RE SORRY!

    Unfortunately you are located in a state that does not allow us to provide remote care for patients.

    Please check back soon, as we are actively working on meeting requirements that will allow patient in your state to use DocBright for virtual dermatology care.

  • WE'RE SORRY!

    Unfortunately all of our providers in your state are currently unavailable. This service disruption in your area is temporary, so please check back soon. We apologize for any inconvenience.

    If we can be of any help in the meantime, plesae email us at CareTeam@docbright.com

  • BEFORE YOU BEGIN

    Please do not use your browser back or forward buttons during the submission process, as this will erase your data to protect your privacy. 

    If you need to return to a previous page, please use the "Back" and "Next" buttons at the bottom of each page.

  • PLEASE VERIFY

    You entered the patient's email address as:

    {patientsEmail}

    Please confirm that this is correct before continuing. If the email address is typed incorrectly, it may delay your care.
  • Patient's Date of Birth*
     - -

  • PLEASE VERIFY

    You entered the patient's date of birth as:

    {patientsDate} ({patientsAge} years old)

    Please confirm that this is correct before continuing. If the date of birth is incorrect, you may have trouble picking up any prescriptions from your pharmacy.
  • Are you the minor patient or the minor patient's parent/guardian?*
  • Patient Gender Assigned at Birth*
  • What is the patient's current gender identity? (check all that apply)*
  • Have you submitted on DocBright before?*

  • WE'RE SORRY!

    Unfortunately you are located in a state that does not allow us to provide remote care for patients.

    Please check back soon, as we are actively working on meeting requirements that will allow patient in your state to use DocBright for virtual dermatology care.

  • WE'RE SORRY!

    Unfortunately all of our providers in your state are currently unavailable. This service disruption in your area is temporary, so please check back soon. We apologize for any inconvenience.

    If we can be of any help in the meantime, plesae email us at CareTeam@docbright.com

  • Your caring dermatology provider.

    Step 2 of 6
  • Today's Featured Provider is Dr. Mitchell J. Mandel, M.D., F.A.A.D. Would you like Dr. Mandel to review your submission?*
  • Today's Featured Provider is Nicole Busche-Earley, PA-C Would you like PA Earley to review your submission?*
  • Today's Featured Provider is Dr. Amit Om, M.D. Would you like Dr. Om to review your submission?*
  • Today's Featured Provider is Dr. Harib Ezaldein, M.D. Would you like Dr. Ezaldein to review your submission?*
  • Today's Featured Provider is Dr. Anna Chacon, M.D. Would you like Dr. Chacon to review your submission?*
  • Today's Featured Provider is Dr. Julie Reil, M.D. Would you like Dr. Reil to review your submission?*
  • Today's Featured Provider is Dr. Mary Noel George, M.D. Would you like Dr. George to review your submission?*
  • Today's Featured Provider is Dr. William Schaffenburg, M.D. Would you like Dr. Schaffenburg to review your submission?*
  • Today's Featured Provider is Dr. Jean-Phillip Okhovat, M.D. Would you like Dr. Okhovat to review your submission?*
  • Today's Featured Provider is Dr. Kimberly Werner, M.D. Would you like Dr. Werner to review your submission?*

  • There is currently only one California provider available:

    Dr. Anna Chacon, M.D.

  • There are currently only two Florida providers available:

    Dr. Anna Chacon, M.D.

    Dr. Katherine Nolan, M.D.

  • Your assigned provider is:

    {providersName}

  • Your assigned provider is:

    {providersName}

  • Dr. Mitchell Mandel, M.D., F.A.A.D., DocBright Dermatologist
  • Dr. Julie Reil, M.D., ABLS, ABFM, DocBright Dermatologist
  • Dr. Julie Reil, M.D., ABLS, ABFM, DocBright Dermatologist
  • Dr. Amit Om, M.D.
  • Dr. Jean Phillip Okhovat
  • Dr. William Schaffenburg
  • Dr. Kimberly Wernet
  • Dr. Anna Chacon
  • Dr. Harib Ezaldein
  • Dr. Michael Anderson
  • Dr. Katherine Nolan
  • Provider Acknowledgment*
  • How would you like us to assign your case?*
  • How would you like us to assign your case?*

  • WE'RE SORRY!

    At this time, there is not an alternate provider available to treat you.

    If you have any questions, don't hesitate to contact us at CareTeam@docbright.com any time.


  • A QUICK HEADS UP

    PA Nicole Busche-Earley is no longer treating patients via DocBright, but don't worry, we've got you covered!

    Your submission will be assigned to Florida-based provider Dr. Anna Chacon, M.D.

  • Tell us about your preferred pharmacy.

    Step 3 of 6
  • In New York, we partner with an online pharmacy, Ravkoo to make it even easier to get your prescriptions for an affordable price. Ravkoo will also deliver your prescriptions to your home same or next day. Would you like to use Ravkoo pharmacy for any prescriptions?
  • How do you intend to pay for any prescriptions?*


  • Pharmacy Information: Your prescriptions will be sent to Ravkoo, our online pharmacy partner. Ravkoo guarantees the lowest price for your prescriptions regardless of insurance coverage. You will receive a text message from Ravkoo once your prescriptions have been sent confirming their pricing. Once confirmed and paid for, your prescriptions will be delivered to you same or next day!


  • IMPORTANT PHARMACY INFORMATION

    In most cases prescription and/or over-the-counter medications are part of patient treatment plans, although we cannot gaurantee that medications will be ordered or filled from a submission.

    Please ensure accurate pharmacy information is entered above. If inaccurate pharmacy information is provided, any prescription(s) will be sent to the pharmacy closest to you for convenience.

    Prescriptions sent after-hours, on the weekends, or during holidays may take longer to fill. Please contact your pharmacy directly to ensure that your prescription has been received and processed prior to pickup.

    If your pharmacy does not have your prescription on file, ensure they are searching by the patient's date of birth. 

    Contact us at CareTeam@docbright.com with any questions.

  • Let's learn about the problem you're experiencing today.

    Step 4 of 6
  • Which of the following best describes the problem you are experiencing?*
  • Are you interested specifically in a prescription for Oral Minoxidil?*
  • Do you have any personal or family cardiovascular history?*
  • Please select all that apply with regard to your shaving-related issue*
  • Do you require any specific language or information to be included in your shaving excusal note?*
  • Is this a follow-up to a previous submission?*
  • How long have you been experiencing your current problem*
  • How would you describe your skin?*
  • What parts of the body are affected? Check all that apply.*
  • Do you experience any of the following? Check all that apply.*
  • Is the problem moving, spreading, or changing? Check all that apply*

  • Help us understand your medical history.

    Step 5 of 6
  • Please check all that apply (or choose none of the above)*
  • Do you have any allergies to food or medication?*
  • Are you currently taking any medications?*
  • Do you have any hobbies or activities that you do regularly? Sometimes our daily activities can provide important insight into why we may be experiencing certain symptoms.*
  • Are you pregnant or nursing?*

  • Let's get your case submitted to your provider!

    Step 6 of 6
  • How did you first hear about DocBright?*
  • If you didn't get virtual care from DocBright, how would you have sought out treatment?*

  • Photo Uploads


  • UPLOAD NOW OR LATER

    If you'd like to upload photos later, you will automatically receive a unique photo upload link via email. You can use this link to easily submit your photos later from a different device, such as an iPhone or Android.

    Please keep in mind that your submission will remain as pending until all required photos have been uploaded.
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  • Provider Consent

  • Format: +1 000 000-0000.

  • Your assigned provider is:

    {providersName}

  • Dr. Mitchell Mandel, M.D., F.A.A.D., DocBright Dermatologist
  • Nicole Busche-Earley, PA-C, DocBright
  • Dr. Amit Om, M.D., DocBright Dermatologist
  • Dr. Harib Ezaledin, M.D., DocBright Dermatologist
  • Dr. Anna Chacon, M.D., DocBright Dermatologist
  • Dr. Kimberly Werner, M.D., DocBright Dermatologist
  • Dr. Julie Reil, MD, ABLS, ABFM, DocBright Dermatologist
  • Dr. Mary George, M.D., DocBright Dermatologist
  • Dr. William Schaffenburg, M.D., DocBright Dermatologist
  • Dr. Jean-Phillip Okhovat, M.D., DocBright Dermatologist
  • Dr. Michael Anderson, M.D., DocBright Dermatologist
  • Dr. Katherine Nolan, M.D., DocBright Dermatologist
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  • IT'S THE WEEKEND!

    You are submitting your case on, or near a weekend. While most cases are still answered within 24 hours on weekends, you may not receive your response until the next business day.
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