Virtual Care Appointment Form
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Select an appointment type
*
Urgent Care Consultation/Other
Sexual Health Consultation
Weight Loss Consultation
Hair Restoration Consultation
Are you a resident of the state of New York? **ReNu Medical/Doctor Skinny Shot is currently only accepting patients who are residents of New York.
*
Yes
Were you referred by someone? If so, who?
*
For any additional appointments not listed below, accommodation's can be made.
Please contact Dr. Mavroson at: Phone/Text: (516)721-2107 or Email: info@doctorskinnyshot.com
Dr. Matthew Mavroson's Available Appointment Dates. Contact
*
My Products
*
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Telehealth Consultation
Consultation Fee for Telehealth Services
$50.00
$
50.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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