Dermatology Solutions offers Telehealth diagnosis and management for acne, rashes, allergies and skin conditions. We offer a complimentary consult with our nurse prior to meeting with the Dermatologist. Our Dermatologists are only a phone call away and with you throughout your entire care.

Refer a Patient

We work closely with health professionals and GPs to support their patients.

Complete the online form below or download the printable referral form to refer your patient for diagnosis and management of inflammatory skin conditions, rashes, acne or our other services.

Patient Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email

Contact Number

(###)

###

####

Referring Health Professional

First Name

Last Name

Referring Clinic

Reason for Referral

Other comments to Dermatologist

Electronic Signature

Enter your full name below to sign electronically

Provider Number

Online Referral Form