Video Consultation Form

1

What is your Main Concern that you would like the Doctor to discuss.

2

Appointment PreferenceWe do our best to accommodate your preference. Our staff will contact you to confirm your appointment time.

3

Best Method for video call

FaceTIme (this is preferred)

Google Hangouts

Zoom

Skype

4

Contact Information* This field is required.

First Name

Last Name

Date Of Birth

Email Address

Cell Phone Number

5

Who Would you like to setup a consultation with?* This field is required.

Selected Doctor

1

Video Consultation - Dr. Dan LandmannDr. Dan Landmann is the inventor of StyeGuy! He has been in practice since 2005 and specializes in just eyelid surgery. Because he is often in surgery, his availability is limited, but he is always happy to help! Dr. Landmann is passionate about helping patients treat their stye as quickly and safely as possible. He has extensive experience and is committed to helping you.
$225.00Edit
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Video Consultation - Nicole GrossbardNicole is an excellent Family Nurse Practitioner, who specializes in oculoplastics. Patients love her detailed explanations, care and attention to detail. She works closely with Dr. Landmann and if there is ever a question, she is able to run cases by Dr. Landmann. Price for a video consultation with her is $125.
$125.00Edit
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Payment Methods

Credit Card

First Name

Last Name

Google Pay

After submitting the form, you will be redirected to the Google Pay to complete the payment process.

Apple Pay

After submitting the form, you will be redirected to the Apple Pay to complete the payment.