Virtual Consultation Form

For Insurance Cases Only*:

*Dermatology & Laser of Del Mar does not accept Medicaid or HMO insurance plans. We do accept most PPO coverage and Medicare. While we do accept insurance for medical dermatology appointments, we cannot guarantee your visit will be covered. That is dependent on your individual plan. Cosmetic Procedures are not billed through insurance. These may be paid by cash, check or major credit card. We also accept financing through Care Credit.

Upload Photos

If you would like to include photos of yourself to assist in evaluating your individual case, you may add them here. Please keep in mind that photo submissions will not take the place of a face-to-face consultation with Dr. Atkin and additional photos may be requested depending on your procedure of interest. To achieve the best quality photos, please:

  • Use a solid color background
  • Take one front facing photo with the face and or body centered, looking straight
  • Take at least one profile photo from each side


Are you a Brilliant Distinctions or Aspire Rewards member?
Are you at or close to your desired body weight?
Areas of Concern:
Are you interested in treatment for the following:
Do you currently have any of the following?
Best Method to Contact You:

For Insurance Cases Only*:

*Dermatology & Laser of Del Mar does not accept Medicaid or HMO insurance plans. We do accept most PPO coverage and Medicare. While we do accept insurance for medical dermatology appointments, we cannot guarantee your visit will be covered. That is dependent on your individual plan. Cosmetic Procedures are not billed through insurance. These may be paid by cash, check or major credit card. We also accept financing through Care Credit.

Upload Photos

If you would like to include photos of yourself to assist in evaluating your individual case, you may add them here. Please keep in mind that photo submissions will not take the place of a face-to-face consultation with Dr. Atkin and additional photos may be requested depending on your procedure of interest. To achieve the best quality photos, please:

  • Use a solid color background
  • Take one front facing photo with the face and or body centered, looking straight
  • Take at least one profile photo from each side

Max. file size: 8 MB.
Max. file size: 8 MB.
Max. file size: 8 MB.
Max. file size: 8 MB.
Max. file size: 8 MB.
Max. file size: 8 MB.
Max. file size: 8 MB.
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