Physician 360 Telehealth Consult
As many patients have used this service in the past, we can refer you to a consult with Physician 360 who has helped patients who may not have a provider but would like to speak to one via telehealth. Please fill out the information below and our team will connect you via email to Physician 360's team for the last step to speak to a provider and receive a script. Skippack Pharmacy is not directly partnered with or affiliated with Physician 360; however, providing referrals to help patients who need a provider. If you have any issues with the consult, please reach out to the Physician 360 team directly --> email: support@myphysician360.com or call: 360-861-6199.
Patient's Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
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Email
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Please double check and ensure this is accurate as you will get an email from Physician 360 at this email address.
Purpose
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Anemia
Birth Control
Coronavirus
Ear Infection
Erectile Dysfunction
Flu
Hair Loss & Regrowth
High Cholesterol
Pain Management
Strep Throat
UTI
Weight Loss
Other
Anything else we should know when we connect you to Physician 360
Signature: By signing below I give Skippack Pharmacy consent to share information from the Interest Form I filled out & data above with the Physician 360 provider's team. Physician 360 providers will utilize that information to reach out to the patient via email for next steps to schedule an appointment. In the event I do not receive any email from Physician 360, I will reach out to their team directly at support@myphysician360.com or by calling them: 360-861-6199.
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