Please complete the fields below to request a Telehealth video visit appointment via Zoom.

    First Name *

    Last Name *

    Date of Birth * (mm/dd/yyyy)

    Phone *

    Email

    Confirm Email

    Insurance Type and Member/Subscriber ID

    Pharmacy Phone Number

    Who would you like to see? *

    What is your appointment for?
    Please be as specific as possible. For example you can say: Acne, Rash, Nail Issue, Hair Loss, Bug Bites, Eczema.

    Please offer at least three dates and times (time ranges are good!) that work for you and we will email back with a confirmation or additional options.

    If necessary, email pictures of the affected area to [email protected] in advance of your telehealth appointment.

    By clicking Send, you are initiating an email to Tribeca Skin Center. Email is not a secure form of communication.