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.