Virtual Consultation Form

Please complete the form below for a preliminary, complimentary evaluation.

Personal Information

Your personal information will not be shared with, or sold to, anyone outside of our organization for any reason.

Personal Profile

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If you have some photos of yourself that you would like to share, please use the upload button below to upload photos to send to us:

To make the most out of your virtual consultation, do your best to submit your photographs in the following format. This will allow Dr. Kaufman to make the most comprehensive assessment.

  1. Use a solid background.
  2. Take one frontal photo with the face or body centered and looking straight.
  3. Take at least one, preferably two profile photos.
Example of a good photo
Example frontal view.
Example of a good photo
Example profile view.
Example of a good photo
Example body frontal view.
Example of a good photo
Example body profile view.
(All the photo file size should be less than 2 MB.)
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Photo2
Photo3
Photo4


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