Consultation Requestfor Dr. Roskies

We appreciate you taking the time to share this information. Dr. Roskies and his team put a great deal of care and attention to detail into every consultation and procedure. We're thankful for your interest and look forward to speaking with you soon.

To finalize your form, please upload clear digital photos of your face and neck for Dr. Roskies and his team to review. These high-quality photos are essential for accurate remote assessments. For best results, please have someone take your pictures in a room with good natural light and a neutral background. Stand a few feet away from the camera, pull your hair back, and ensure the camera lens is at eye level with your chin parallel to the floor. Make sure both your face and neck are visible in the frame. Thank you!

*PDF or JPG Files only (Total File Size must be under 20mb)

Please note, communications through our website or via email are not encrypted and are not necessarily secure. By submitting this form, you are granting Dr. Mike Roskies and his team have permission to review your photos. These photos will only be used in-house for consultation purposes.*

Front*

Left Profile*

Right Profile*

Left Oblique*

Right Oblique*

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