| Doctors Online Appointment Request |
 |
Thank You, {name} for Sending us your Appointment Request, Please note that our Skin Care Representative will call you to verify and if needed reschedule your appointment. Please keep your Mobile open for our call as soon as possible.we will be processing your request during business hours (8AM-5PM, Monday -Friday) and the next day for outside business hours
APPOINTMENT INFORMATION
| Date & Time of prefferred Appointment |
Reference # |
Virtual Consulatation Platform |
| {yourPreferred} |
{id} |
{modeOf} |
Please note that your Appointment is subject to change due to the high demand of our doctors. We will do our best to fit you in on your preferred time. If your time and date is subject to change rest assured that our Skin Care Representatives will contact you Immediately.
PATIENTS PERSONAL INFORMATION
| Patients Full Name |
Birthdate |
Sex |
| {name} |
{birthdate} |
{gender} |
CONTACT INFORMATION
| Email Address |
Contact Number |
| {emailAddress} |
{mobileNumber} |
Please Keep your Lines and Email Address Open as we will contact you to verify your appointment and Payment Confirmation
PATIENT HISTORY STATEMENTS
| Current Patient of Dermstrata |
Skin Concerns for Consultation |
| {input6} |
{whatAre} |
Reason Concerned Topics and Photo
| Complaints regarding concerns |
Photo of Concerned Area |
| {whatAre9} |
Feature Not available |
Other Medical Information
| Medications that patient is intaking |
Other Medical Information to
furthur assist the assigned Doctor |
| {pleaseList} |
{otherInformation} |
Mode of Payment: {preferredMode}
Thanks for choosing {preferredMode} a Skin Care representative will call you to complete the transaction.
TERMS AND CONDITIONS
Any changes that you would like to request such as but not limited to; Change of Schedule Medical Information Changes or Contact Number, you may message our Dermstrata Facebook Page to get in touch with our Skin Care Representatives
In case of rescheduling without a fixed date your payment to our doctors is valid up until 2 weeks after your reservation.
When payment is confirmed, and Online Consultation has been transacted refunds is longer applicable.
rescheduling your appointment requires 1 day in advance notice to our doctors in order to make adjustments to their schedules.
Due to Signal and Internet Intermittent issues that may arise during your consultation. Our Doctor may recommend to the patient that the call maybe transferrred to cellular number (voice) and still counts as a successful valid consultation.
Your preferred Online Platform may not be available due to 3rd party system issues we therefor will contact you of a change of platform if needed.
Once Transaction has been fully made please prepare and download the necessary app (messenger ) on your phone/tablet/pc with a decent Internet Connection Signal.
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