CheckMark Derm

See a Doctor 100% Covered By Your

BC Health Card

All your information is kept strictly confidential and 100% secure. For life-threatening emergencies call 911. If you are suffering an acute mental health crisis call 1-833-456-4566.
Please acknowledge that you meet the following criteria:
- Are 18 years of age or older
- Have one or two specific spots, moles, or marks you're concerned about, and that the spots are not in an intimate area or covered by hair or tattoos
- Are not seeking a full skin exam
- Are comfortable having photos taken by a trained technician rather than a dermatologist in person
Is this appointment for you or for your dependent?
Are you a returning patient?
Is your dependent a returning patient?
Patient Information
Patient name

First NameLast Name
Pronouns
Please select "Other" to provide the patient's preferred pronouns
Please enter the preferred pronouns
Date of birth

MonthDayYear
Date
Sex assigned at birth
Gender identity
Please select "Other" to provide the patient's preferred gender identity
Please enter the preferred gender identity
Email address
example@example.com
Phone number
Please enter a valid phone number.Format: +1 (000) 000-0000.
Address

Street Address

Street Address Line 2

CityProvince

Postal Code

Caregiver/Guardian Information
What is your name?

First NameLast Name
Pronouns
Please select "Other" to provide your preferred pronouns
Please enter your preferred pronouns
Date of birth

MonthDayYear
Date
Email address
example@example.com
Phone number
Please enter your phone number
Please enter a valid phone number.Format: +1 (000) 000-0000.
Address
Please enter your address

Street Address

Street Address Line 2

CityProvince

Postal Code

Placeholder Email
BC Health Card Number

This allows us to offer your appointment for free. If you don't have this handy you can provide it before your appointment.
Do you have a current/valid BC Health Card Number?
Does your dependent have a current/valid BC Health Card Number?
Expiration date

MonthDayYear
Date

Is this a new concern or a follow-up appointment?
Would you like us to try and match you with the last Doctor who saw you if he/she is available?
Would you like us to try and match your dependent with the last Doctor who saw your dependent if he/she is available?

What is the main reason you want to see a doctor?
" If you are experiencing severe chest pain or shortness of breath, please call 911 and/or go immediately to the nearest emergency department. "
What is the main reason your dependent want to see a doctor?
Please select one of the following medications for a prescription refill.
If you don't see your medication, please select "Other" to type out the name of your medication.
Please type out the name of your medication(s).
Please type out the name of your dependent's medication(s).
Tell us more. Please describe the details for your visit.
Tell us more. Please describe the details for your dependent's visit.
Are you a Veteran?
Please enter your Blue Cross ID
Do you currently have a family doctor?
Would you be interested in registering with a group of physicians (with Rocket Doctor) to be your family doctor
Would you be able to travel to 4882 Main St, Vancouver, BC V5W 2R3 for in-person appointments - only when required by the doctors?
* Sorry, we are only currently able to offer this service to patients that can travel to the specified clinic address.

*By requesting an appointment, you agree to Rocket Doctor’s Terms and Conditions, Email Communications Policy and Privacy Policy.
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Patient Information