Virtual Assessment

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At DermaSpa at Bend Dermatology Clinic, we’re making it easier than ever to begin your Cosmetic Dermatology journey with our new Virtual Intake service. Patients can securely submit photos and essential details about their skin concerns with just a few simple steps. Our team will carefully review each submission and contact you with next steps.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Date of Birth(Required)

Procedure(s) of Interest(Required)

Cosmetic Injectables

Fine Lines/Texture/Tone

Brown & Red Pigment

Laser Hair Reduction

Non-Invasive Skin Tightening

Non-Invasive Medical-Grade Facial Treatments

Medical-Grade Skin Care

Message

Photo Upload:

Please submit your photos through the form below. This allows our team to review your information in advance and determine if you may be a good candidate for desired treatments, which will help expedite the process.

Photo #1 (Front Angle)(Required)

Max. file size: 75 MB.

Photo #2 (Side Profile)(Required)

Max. file size: 75 MB.

Photo #3 (3/4 Angle)(Required)

Max. file size: 75 MB.

Photo Upload: